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Liquid resorbable nanofibrous surgical mesh: a proof of a concept

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Abstract

Background

Surgical mesh is widely used not only to treat but also to prevent incisional hernia formation. Despite much effort by material engineers, the 'ideal' mesh mechanically, biologically and surgically easy to use remains elusive. Advances in tissue engineering and nanomedicine have allowed new concepts to be tested with promising results in both small and large animals. Abandoning the concept of a pre-formed mesh completely for a ‘pour in liquid mesh’ has never been tested before.

Materials and methods

Thirty rabbits underwent midline laparotomy with closure using an absorbable suture and small stitch small bites technique. In addition, their abdominal wall closure was reinforced by a liquid nanofibrous scaffold composed of a fibrin sealant and nanofibres of poly-ε-caprolactone with or without hyaluronic acid or the sealant alone, poured in as an ‘onlay’ over the closed abdominal wall. The animals were killed at 6 weeks and their abdominal wall was subjected to histological and biomechanical evaluations.

Results

All the animals survived the study period with no major complication. Histological evaluation showed an eosinophilic infiltration in all groups and foreign body reaction more pronounced in the groups with nanofibres. Biomechanical testing demonstrated that groups treated with nanofibres developed a scar with higher tensile yield strength.

Conclusion

The use of nanofibres in a liquid form applied to the closed abdominal wall is easy to use and improves the biomechanical properties of healing fascia at 6 weeks after midline laparotomy in a rabbit model.

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Acknowledgements

The author team would like to thank Doc MVDr Josef Illek DrSc Dipl ECBHM from University of Veterinary and Pharmaceutical Sciences in Brno, Czech Republic and doc RNDr Ján Sabo, CSc from University Centre for Energy Efficient Buildings, Czech Technical University in Prague for their support and mentorship thought the course of the experiment.

Funding

This research has been supported by a grant from the Czech Health Research Council Reg No. 17-32285A and by a research grant from the European Hernia Society.

Author information

Author notes

  1. B. East and J. Woleský have contributed equally.

Authors and Affiliations

  1. 3rd Department of Surgery, 1st Faculty of Medicine, Motol University Hospital, V uvalu 84, 150 06, Prague, Czech Republic

    B. East & J. Woleský

  2. Department of Biophysics, 2nd Faculty of Medicine, Charles University, V uvalu 84, 150 06, Prague, Czech Republic

    R. Divín, V. H. Blahnová & E. Amler

  3. University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43, Buštěhrad, Czech Republic

    R. Divín, K. Vocetková, V. Sovková, V. H. Blahnová & E. Amler

  4. Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20, Prague, Czech Republic

    K. Vocetková, V. Sovková & V. H. Blahnová

  5. Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University in Prague, Sitna 3105, 272 01, Kladno, Czech Republic

    M. Otáhal

  6. Department of Pathology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V uvalu, 15006, Prague, Czech Republic

    M. Koblížek

  7. Department of Surgery & Orthopaedics, Faculty of Veterinary Medicine, Small Animal Clinic, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic

    A. Nečasová & J. Lorenzová

  8. Large Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic

    A. Staffa

  9. Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University in Prague, Jose Martího 31, 162 52, Prague 6, Czech Republic

    M. Otáhal & P. Kubový

  10. Royal Infirmary, Department of General Surgery, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK

    A. Ch. de Beaux

Authors
  1. B. East
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  2. J. Woleský
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  3. R. Divín
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  13. J. Lorenzová
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  14. E. Amler
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Corresponding author

Correspondence to B. East.

Ethics declarations

Conflict of interest

We were uploaded for each author individually.

Ethical approval

All procedures performed within this study were approved by the Ministry of Education of the Czech republic (approval no.11921/2017-4) and were in accordance with the Euroepan Union ethical standards for animal reserach.

Human and animal rights

We have confirmed to the Act. No. 246/1992 Coll., as amended, and Decree No. 419/2012 Coll., on the protection of experimental animals.

Informed consent

We do not have informed consent as this is an animal trial.

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Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract submitted to Hernia21, the Annual Congress of the European Hernia Society, Copenhagen, October 2021 and has won the BJS hernia prize.

Supplementary Information

Below is the link to the electronic supplementary material.

10029_2022_2582_MOESM1_ESM.docx

Supplementary file1 (DOCX 86 KB) Supplementary Fig. 1 1a: Particle size distribution of milled PCL/HA+PL scaffold. 1b Distribution of fibre diameter size of PCL nanofibre scaffold. 1c Distribution of fibre diameter size of PCL/HA nanofibre scaffold. Particle size distribution after milling process was distributed according to log-normal distribution with peak in a range of 10 µm to 20 µm. The size of individual particles was determined as twice the semi-major axis of ellipse fitted to the measured particle. The measured particles in the range of 10 µm to 20 µm made up only 3 % to 5 % of total particles mass in the prepared sample. The milling process, particle surface morphology, nanofibre surface chemistry, humidity and chemistry of the environment caused many of the small milled particles to connect to create cluster like larger particles with nanofibre structure

Supplementary file2 (DOCX 205 KB) Supplementary Figure 2 Sample harvesting

10029_2022_2582_MOESM3_ESM.docx

Supplementary file3 (DOCX 188 KB) Supplementary Figure 3 Tissue composition of surgical wound. Boxplot of percentage of connective tissues (dense and loose together). (I - Artiss, II - PCL+Artiss, III - PCL/hPL+Artiss, IV - PCL/HA+Artiss, V - PCL/HA+hPL+Artiss)

10029_2022_2582_MOESM4_ESM.docx

Supplementary file4 (DOCX 13 KB) Supplementary Table 2 Standard T-test to determine statistical signifikance of the difference between the elastic modulus and dissipative energy density of group IV compared to other groups.

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East, B., Woleský, J., Divín, R. et al. Liquid resorbable nanofibrous surgical mesh: a proof of a concept. Hernia 26, 557–565 (2022). https://doi.org/10.1007/s10029-022-02582-1

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