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4 Hernia Materials: Fundamentals ofProsthetic Characteristics
37
Table 4.1 Permanent synthetic meshes for hernia repair subdivided by the presence/absence of a barrier, coating, or reinforcing material
Bare
Polypropylene (PP)
3D Max (Bard/Davol Inc.) 3D Max Light (Bard/Davol
a
Inc.) Bard Mesh (Bard/Davol Inc.) Bard Soft Mesh (Bard/Davol Inc.) DynaMesh-PP Light (FEG Textiltechnik mbH) DynaMesh-PP Standard (FEG Textiltechnik mbH) EASY PLUG PATCH SYSTEM (Aspide/BG Medical)
a
Freedom Octomesh (Insightra Medical) Kugel Patch/Modied Kugel Patch (Bard/Davol Inc.) Marlex (Bard/Davol Inc.) MK Hernia Patch (Bard/Davol Inc.) Optilene Mesh (B Braun) Optilene Mesh Elastic (B Braun) Optilene Mesh LP (B Braun) Optilene Mesh Plug (B Braun) Parietene (Covidien) PerFix Light Plug (Bard/Davol
a
Inc.) PerFix Plug (Bard/Davol Int.) Polysoft Hernia Patch (Bard/ Davol Inc.) Premilene Mesh (B Braun) Premilene Mesh Plug (B Braun) PROLENE 3D Patch (Ethicon
a
Inc.) PROLENE Mesh (Ethicon Inc.) PROLENE Polypropylene Hernia System (Ethicon Inc.) PROLENE Sort Mesh (Ethicon Inc.) ProFlor (Insightra Medical) ProLite Mesh (Atrium
Barriers and coatings
Permanent
a
Permanent barrier, noncomposite Expanded polytetrauoroethylene (ePTFE)
CRURASOFT Patch (Bard/Davol Inc.) DUALMESH Biomaterial (W.L.Gore & Assoc. Inc.) DUALMESH PLUS Biomaterial (W.L.Gore & Assoc. Inc.) DULEX Mesh (Bard/Davol Inc.) MYCROMESH Biomaterial (W.L.Gore & Assoc. Inc.) MYCROMESH PLUS Biomaterial (W.L.Gore & Assoc. Inc.) Reconix Reconstruction Patch (Bard/Davol Inc)
Permanent barrier, composite PP+ePTFE
Composix (Baid/Davol Inc.) Composix E (Bard/Davol Inc.) Composix F/X (Bard/Davol Inc.) Composix Kugel Patch (Bard/ Davol Inc.) Composix L/P (Bard/Davol Inc.) CK Parastomal Hernia Patch (Bard/ Davol Inc.) Ventralex Hernia Patch (Bard/
a
Davol Inc.) VENTRIO Hernia Patch (Bard/ Davol Inc.)
PP+silicone
SURGIMESH XB (Aspide/BG Medical)
Permanent coating PP+Titanium
TIMESH Extralight (Biomet Biologics/GfE Med. GmbH) TIMESH Light (Biomet Biologics/
a
GtE Med. GmbH) T1MESH Strong (Biomet Biologics/GfE Med. GmbH)
a
Resorbable
Reinforced
Resorbable Fibers PP+glycolide/ε- caprolactone
SERAMESH PA (Serag Wiessner) ULTRAPRO Hernia System (Ethicon Inc.)
a
ULTRAPRO Mesh (Ethicon Inc.) ULTRAPRO Plug (Ethicon Inc.)
a
PP+glycolide/lactide VYPRO Mesh (Ethicon Inc.) VYPRO II Mesh (Ethicon Inc.)
Medical Corp.) ProLite Ultra Mesh (Atrium Medical Corp.) ProLoop Mesh (Atrium Medical Corp.)
a
(continued)
38
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C. R. Deeken and S. P. Lake
Table 4.1
(continued)
Bare SURGIMESH WN (Aspide/
BG Medical) Surgipro Polypropylene Monolament (Covidien) Surgipro Multilament Polypropylene (Covidien) Surgipro Polypropylene Open Weave (Covidien) VISILEX Mesh (Bard/Davol Inc.) VITAMESH™ (Proxy Biomedical.) VITAMESH™ BLUE (Proxy Biomedical)
Polyester (PET)
MERSILENE Mesh (Ethicon Inc.) Parietex Anatomic Mesh (Covidien) Parietex Flat Sheet 2D Weave (TEC) Mesh (Covidien) Parietex Flat Sheet 3D Weave (TET) Mesh (Covidien) Parietex Folding Mesh (Covidien) Parietex Easegrip Mesh (Covidien) Parietex Lightweight Monolament Polyester Mesh (Covidien) Parietex ProGrip Self-Fixating Mesh (Covidien) Parietex Plug and Patch System (Covidien)
a
Versatex (Covidien)
Polytetrauoroethylene (PTFE) Condensed PTFE
Omyra Mesh (B Braun)
Macroporous PTFE
INFINIT Mesh (W.L.Gore & Assoc. Inc.) MotifMesh (Proxy Biomedical)
POLYVINYUDENE FLUORIDE (PVDF)
DynaMesh-CICAI (FEG Lextiltechnik mbH) DynaMesh-ENDOLAP (FEG Textiltechnik mbH) DynaMesh-Lithtensteiri (FEG Lextiltechnik mbH)
Barriers and coatings
Resorbable barrier, composite PP+glycolide/ε-caprolactone
PHYSIOMESH (Ethicon Inc.)
PP+glycolide/caprolactone/trim ethylene carbonate
Parietene DS Composite Mesh (Medtronic)
PP+sodium hyaluronate/carbox ymethylcellulose/polyethylene glycol
Sepramesh (Bard/Davol Inc.) Sepramesh IP COMPOSITE (Bard/ Davol Inc.) Ventralex ST Hernia Patch (Bard/ Davol Inc.) VENTRALIGHT ST Mesh (Bard/ Davol Inc.) VENTRIO ST Hernia Patch (Bard/ Davol Inc.)
PP+oxidized regenerated cellulose
PROCEED Surgical Mesh (Ethicon Inc.) PROCEED Ventral Patch (PVP) (Ethicon Inc.)
PP+polyvinylpyrrolidone/ polyethylene glycol
Adhesix (Cousin Biotech) PP+omega-3 fatty acid C-QUR Mesh (Atrium Medical Corp.) C-QUR Mosaic Mesh (Atrium Medical Corp.) C-QUR TacShield (Atrium Medical Corp.) C-QUR V-Patch (Atrium Medical Corp.)
PET+type 1 collagen
Parietex Composite (PCO) Mesh (Covidien) Parietex Composite Hiatal (PCO 2H) Mesh (Covidien) Parietex Composite Open Skirt (PCO OS) Mesh (Covidien) Parietex Composite Parastomal (PCO) Mesh (Covidien) Parietex Composite Ventral Patch (Covidien) Symbotex (Covidien)
PTFE+polyglycolic acid/ trimethylene carbonate
Gore Synecor Biomaterial (W.L Gore)
Reinforced
4 Hernia Materials: Fundamentals of Prosthetic Characteristics
39
Bare
Combinations PTFE+PP
Rebound HRD(MMDI) Rebound HRDV(MMDI)
PVDF+PP
DynaMesh-IPOM (FEG Textiltechnik mbH)
Terms of Use: This table is licensed under a Creative Commons Attribution 4.0 License (https://
creativecommons.org/licenses/by/4.0/) attributed to Corey Deeken and Spencer Lake. The original
version can be found here: https://doi.org/10.1016/j.jmbbm.2017.05.008. The content of the origi­nal table is reprinted here with the addition of subcategory headings/descriptions [4]
a
Available in preformed shapes
Barriers and coatings
Gore Synecor Preperitoneal Biomaterial (W.L.Gore)
Resorbable coating Omega-3 fatty acid
C-QUR FX Mesh (Atrium Medical Corp.) C-QUR Lite Mesh (Atrium Medical Corp.) C-QUR CENTRIFX (Atrium Medical Corp.)
Biological tissue-derived PP+non-crosslinked porcine small intestine submucosa
Zenapro
a
T
(Cook Medical)
Reinforced
Permanent synthetic meshes are also commonly paired with resorbable compos­ite barriers, resorbable coatings, or biological tissue-derived barriers (Table4.1, col­umn 2). Resorbable composite barriers are comprised of a variety of substances, including: sodium hyaluronate/carboxymethylcellulose/polyethylene glycol hydro­gel, omega-3 fatty acid, glycolide/caprolactone/trimethylene carbonate, type I col­lagen, oxidized regenerated cellulose, glycolide/ε-caprolactone, polyvinylpyrrolidone/polyethylene glycol, and polyglycolic acid/trimethylene car­bonate. Omega-3 fatty acid coating represents the only resorbable coating currently available (C-QUR™ FX Mesh, C-QUR Lite™ Mesh, and C-QUR™Centrix Mesh, Atrium/Maquet Getinge Group (Hudson, NH)). In addition, a permanent synthetic base scaffold (polypropylene) has recently been combined with a biological tissue­derived anti-adhesive barrier (non-crosslinked porcine small intestine submucosa), creating a “hybrid” mesh construct that spans both synthetic and biological realms
®
(Zenapro
Hybrid Hernia Repair Device, Cook Medical, Bloomington, IN). Finally, permanent synthetic meshes have also been combined with resorbable bers (Table4.1, column 3) such as glycolide/ε-caprolactone or a co-polymer of glycolide and lactide that provide initial mechanical support at the defect site and then gradu­ally resorb, transferring the load back to the native tissue and leaving a permanent scaffold for long-term mechanical support.
The second major category of hernia repair materials includes resorbable polymers such as poly-4-hydroxybutyrate, ultra-pure broin derived from silk, polyglycolic acid, a co-polymer of glycolide and lactide, aco-polymer of polyglycolic acid and trimethylene carbonate, and a co-polymer of glycolide, lactide, and trimethylene car­bonate (Table4.2). The majority of scaffolds in this category are available as bare meshes, without coatings, barriers, or reinforcements (Table4.2, column 1) and are designed to provide initial mechanical support to the defect without the long-term
40
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Table 4.2 Resorbable meshes for hernia repair subdivided by the presence/absence of a barrier, coating, or reinforcing material
Bare Barriers and coatings
Poly-4-hydroxybutyrate (P4HB)
Phasix™ Mesh (Bard/Davol Inc.)
Ultra-pure broin from silk
Seri Scaffold (Sofregen Medical)
Polyglycolic acid (PGA)
Sal Mesh (B Braun)
Co-polymer of glycolide and lactide
DEXON Mesh (Covidien) VICRYL Knitted/Woven Mesh (Ethicon Inc.)
Co-polymer of polyglycolic acid and trimethylene carbonate
BIO-A Tissue Reinforcement (W.L.Gore & Assoc. Inc.) BIO-A Hernia Plug (W.L.Gore & Assoc. Inc.)
Co-polymer of glycolide, lactide, and trimethylene carbonate
TIGR Matrix Surgical Mesh (Insightra Medical)
Terms of Use: This table is licensed under a Creative Commons Attribution 4.0 License (
creativecommons.org/licenses/by/4.0/) attributed to Corey Deeken and Spencer Lake. The original
version can be found here: https://doi.org/10.1016/j.jmbbm.2017.05.008. The content of the table is reprinted here with additional descriptions of the material composition of the devices [4]
Resorbable barrier, composite
P4HB+hydrogel (sodium hyaluronate, carboxymethylcellulose, and polyethylene glycol
Phasix™ ST Mesh (Bard/Davol Inc.)
C. R. Deeken and S. P. Lake
https://
presence of a permanent implant. There is currently a single fully resorbable compos­ite mesh with a resorbable barrier layer (Table4.2, column 2) that deserves mention as a particularly unique design. This device is comprised of a biologically derived resorbable base scaffold of poly-4-hydroxybutyrate paired with a resorbable compos­ite barrier layer containing a hydrogel of sodium hyaluronate/carboxymethylcellu­lose/polyethylene glycol (Phasix™ ST Mesh, C.R. Bard, Inc./Davol, Warwick, RI).
The third fundamental category of hernia repair materials encompasses biologi­cal tissue-derived scaffolds, which are comprised of extracellular matrices (ECM) derived from dermis, pericardium, rumen, and small intestine submucosa of human, porcine, bovine, and ovine sources (Table4.3). The tissues are subjected to several processing steps including decellularization and sterilization to remove native cells and improve biocompatibility. Some of these materials are also intentionally cross­linked in an effort to improve the mechanical strength of the scaffold and resistance to enzymatic degradation. As with the other categories described above, the major­ity of scaffolds in this category are bare meshes, without coatings, barriers, or rein­forcements (Table 4.3, column 1). However, there are two unique designs that warrant discussion. The rst is comprised of a non-crosslinked porcine dermis scaf­fold combined with an antimicrobial coating of rifampin/minocycline (Table 4.3,
4 Hernia Materials: Fundamentals ofProsthetic Characteristics
41
Table 4.3 Biological tissue-derived scaffolds for hernia repair subdivided by the presence/ absence of a barrier, coating, or reinforcing material
Bare
Barriers and coatings
Reinforced
Non-crosslinked Non-crosslinked Non-crosslinked, ovine
rumen
Bovine (fetal) dermis Porcine
dermis+antimicrobial
Permanent bers
(polypropylene) coating (rifampin/ minocycline)
SurgiMend Collagen Matrix (TEI Biosciences Inc.)
XenMatrix Graft (Bard/Davol Inc.)
AB Surgical
OviTex Reinforced
BioScaffold with Permanent
Polymer (TELA Bio)
Bovine pericardium Permanent bers+barrier
(polypropylene)
®
Veritas
Collagen Matrix
(Insightra)
OviTex 1S Reinforced
BioScaffold with Permanent
Polymer (TELA Bio)
OviTex 2S Reinforced
BioScaffold with Permanent
Polymer (TELA Bio)
Human dermis
AlloDerm Tissue Matrix (LifeCell Corp.)
AlloMax Surgical Graft (Bard/Davol Inc.)
Resorbable bers
(polyglycolic acid)
OviTex Reinforced
BioScaffold with Resorbable
Polymer (TELA Bio)
FlexHD Acellular Dermis (MTF/Ethicon Inc.)
DermaMatrix Acellular Dermis (Synthes Inc.)
Resorbable bers+barrier
(polyglycolic acid)
OviTex 1S Reinforced
BioScaffold with Resorbable
Polymer (TELA Bio)
OviTex 2S Reinforced
BioScaffold with Resorbable
Polymer (TELA Bio)
Porcine dermis
Fortiva (RTI Biologics) Strattice Reconstructive
Tissue Matrix (LifeCell Corp.)
XCM Biologic Tissue Matrix (Ethicon)
XenMatrix
Surgical Graft
(Bard/Davol Inc.)
Porcine liver
Miromesh Biologic Matrix (Miromatrix Medical Inc.)
(continued)
42
C. R. Deeken and S. P. Lake
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Table 4.3 (continued)
Bare
Porcine mesothelial matrix
Medeor Matrix (Kensey Nash Corp.)
Meso BioMatrix Scaffold (Kensey Nash Corp.)
Porcine small intestine submucosa
Surgisis/Biodesign Hernia Grafts (Cook Medical)
Surgisis FM/Biodesign Hernia Grafts (Cook Medical)
Porcine urinary bladder
MatriStem (ACell, Inc.)
Crosslinked
Bovine pericardium
Peri-Guard Repair Patch (Synovis)
Supple Peri-Guard Repair Patch (Synovis)
Porcine dermis
CollaMend Implant (Bard/ Davol Inc.)
CollaMend FM Implant (Bard/Davol Inc.)
Permacol Surgical Implant (Covidien)
Porcine pericardium
XI-S+
(Colorado
Therapeutics LLC)
Barriers and coatings
Reinforced
Terms of Use: This table is licensed under a Creative Commons Attribution 4.0 License (https://
creativecommons.org/licenses/by/4.0/) attributed to Corey Deeken and Spencer Lake. The original
version can be found here: https://doi.org/10.1016/j.jmbbm.2017.05.008. The content of the table is reprinted here with additional descriptions of the material composition of the devices [4]
column 2) designed to reduce or inhibit microbial colonization (XenMatrix™ AB Surgical Graft, C.R. Bard, Inc./Davol, Warwick, RI). The second is a series of ovine rumen ECM-based products that are reinforced with permanent or resorbable poly­mer bers, with or without barrier layers (Table4.3, column 3) (OviTex™ product line, TELA Bio, Malvern, PA). These “hybrid” mesh constructs span both synthetic and biological realms, and as such, provide unique characteristics and benets. In the case of the OviTex™ Core Reinforced BioScaffolds with Permanent Polymer, four ovine rumen ECM layers are reinforced with a sewn 6 mm pattern of
4 Hernia Materials: Fundamentals ofProsthetic Characteristics
43
permanent synthetic polypropylene bers. To this, the OviTex™ 1S and OviTex™ 2S Reinforced BioScaffolds with Permanent Polymer designs (TELA Bio, Inc., Malvern, PA) add two additional layers of ECM with a 25mm pattern on either one or both sides for a total of 6 or 8 layers per implant, respectively. The additional layers serve as barriers. In these designs, the biological tissue-derived matrix is eventually remodeled, leaving behind only the permanent polypropylene bers or layer. Alternatively, the ovine rumen ECM is reinforced with resorbable polygly­colic acid bers in the OviTex™Core Reinforced BioScaffolds with Resorbable Polymer design. Here again, the OviTex™ 1S and OviTex™ 2S Reinforced BioScaffolds with Resorbable Polymer designs (TELA Bio, Inc., Malvern, PA) add two layers on one or both sides, creating fully resorbable, reinforced constructs. This design strategy seeks to optimize initial support of the defect without the dis­advantages of a long-term, permanent implant.
In addition to composition, surgeons must also understand the physical and mechanical characteristics associated with these materials in order to inform mesh selection. Physical characteristics such as pore size/lament diameter, thickness, and area density are typically determined through morphometric analysis, laser micrometry, and the use of an electronic balance, respectively [7, 8]. The physical properties of hernia repair materials have previously been dened along a contin­uum of increasing foreign material in order to unify the terminology used to describe these biomaterials and to provide insight into the amount of foreign material in a given design [7, 8]. Pore size was previously dened as microporous (diameter:
2
<100 μm; area: <0.008 mm
), small pores (diameter: 100–600 μm; area: 0.008–
0.28mm2), medium pores (diameter: 600–1000μm; area: 0.28–0.79mm2), large pores (diameter: 1000–2000μm; area: 0.79–3.14mm2), or very large pores (diam­eter: >2000 μm; area: >3.14 mm2). Fiber diameter was dened as very large (>200μm), large (175–200μm), medium (150–175μm), small (125–150μm), or very small (<125μm). Thickness was dened as extra thick (>1.5mm), thick (1.0–
1.5mm), medium (0.75–1.0mm), thin (0.5–0.75), or very thin (<0.5mm). Finally,
2
area density was dened as heavy-weight (>90g/m
), medium-weight (50–90g/ m2), light-weight (35–50g/m2), and ultra-light-weight (<35g/m2). Multiple clinical studies have documented improved abdominal compliance with less restriction, pain, and foreign body sensation with increasing pore size and decreasing area den­sity [911]. These results are conrmed in the preclinical literature: Klinge etal. reported improved tissue integration with less inammation associated with an ultra-light-weight, large pore mesh compared to a heavy-weight, small pore mesh in a rat model [12]. Similarly, Lake etal. reported a signicant impact of pore size and shape in a porcine study of prototype meshes with varying pore size, shape, and area density [13]; tissue ingrowth strength, as well as neovascularization and brosis, were signicantly improved in meshes with larger pores, particularly those of a hexagonal shape.
In addition to physical characteristics, mechanical characteristics play an impor­tant role in hernia repair. Mechanical properties of mesh materials are determined through a variety of techniques, including suture retention, tear resistance, ball burst, uniaxial tensile, and planar biaxial tensile testing [7, 8, 14]. Suture retention
44
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C. R. Deeken and S. P. Lake
testing is performed by passing a suture surrogate, typically a stainless steel wire, through the material 1cm from the edge and applying tension to the material until failure occurs. Suture retention strength is dened as the maximum load sustained prior to failure [7, 8]. Tear resistance testing is typically performed in an effort to understand the resistance that a material provides against the propagation of a tear once a tear has been initiated. To accomplish this, a small tear of a dened length (typically 2.54cm long) is created in the mesh, leaving two tabs on either side of the tear. Tension is applied to the tabs, and the force required to fully propagate the tear across the mesh is recorded as the tear resistance strength [7, 8]. Ball burst testing is another common method of material characterization. In ball burst testing, the mesh is clamped in a test xture, and a stainless steel ball is applied against the mesh in compression until failure occurs and the ball bursts through the mesh [7, 8]. Uniaxial tensile testing is accomplished by subjecting a strip of mesh to tension in a single direction, while planar biaxial tensile testing applies tension in two, orthogonal directions [7, 8, 14]. Material properties such as ultimate tensile strength, stiffness, and strain can be calculated from ball burst testing. In addition to these properties, tensile testing can also quantify anisotropy (i.e., direction dependence of the mechanical response). Planar biaxial testing realistically simulates the conditions of the human abdomen and provides additional insight into properties such as nonlin­earity and hysteresis, providing a signicant advantage over other methods of testing.
Guidelines for appropriate mechanical properties of biomaterials utilized for her­nia repair applications have been derived from the results of both preclinical studies and theoretical calculations. In a bench top study in which hernia repair materials were attached to porcine abdominal wall tissue with various xation devices, Melman etal. reported that a single polypropylene suture resisted a maximum load of 20N when the mesh-tissue construct was subjected to lap shear testing [15]. Failure occurred in the porcine tissue, while the mesh remained intact. It was therefore rec­ommended that hernia repair materials withstand at least 20N at each suture point in order to reinforce the tissue to which it is attached. This rationale was also extended to guidelines for tear resistance values. In another series of studies, the human abdo­men was modeled as a thin-walled pressure vessel [
7, 8]. A range of possible tensile
stress values were calculated when intra-abdominal pressure and abdominal circum­ference were varied to account for a range of possible patient scenarios. The largest abdominal circumference with the greatest intra-abdominal pressure resulted in the greatest tensile stress on the human abdomen (47.8N/cm); a threshold value of 50N/ cm (ball burst strength) was selected to account for this theoretical scenario. Specimens of abdominal wall tissue obtained from human cadavers exhibited strain values in the range of 10–30% during tensile testing, leading Junge etal. to recom­mend this range of values for hernia repair applications [16].
The physical and mechanical characteristics of over 50 hernia repair materials have been comprehensively characterized by our group [7, 8, 14, 1722] and others [12, 2341] and are summarized in Tables 4.4 and 4.5 [4]. These tables demonstrate the wide range of both physical and mechanical properties available in current her­nia repair materials, with the greatest variation apparent in the values reported for
4 Hernia Materials: Fundamentals ofProsthetic Characteristics
45
Table 4.4 Summary of the physical properties of a subset of available hernia repair materials, including pore size/lament diameter, thickness, and area density
Diameter Diameter of pores (mm)
Area of pores (mm
of bers
2
(μm)
)
Thickness (mm)
Density (g/
2
m
)
References
Permanent synthetic Bare
Bard Mesh 0.44–0.58 185.7 0.73–0.76 102.4–105 [8, 27] Bard Soft Mesh 2.5 44 [28, 29] Dyna-Mesh 4.16 36 [23] INFINIT 4 116.2 0.16 65.6–70 [8, 23] Marlex 0.46 0.63 95 [12, 2931] MERSILENE
1.0 33–40 [29, 32, 33]
Mesh Optilene Mesh 1.0 7.64 36–48 [23, 28, 29,
34]
Parietene 1.0–1.6 0.53 77–78 [29, 30, 35] Parietene Light 1.5–1.7 0.36 36–38 [2830, 36] Parietex Flat
2.0 1.75 338.8 0.52–0.53 100–119.2 [8, 30] Sheet 2D Mesh (TEC)
Parietex (TECR) 2.0 0.53 120 [30] PROLENE Mesh 0.8–1.6 0.39 130.4 0.51–0.53 79.5–108 [8, 2932,
37]
ProLite Mesh 0.8 0.33 151.2 0.47 85–90 [8, 29, 31,
38]
ProLite Ultra
0.34 99.0 0.39 50.1 [8]
Mesh Serapren 0.08–0.1 116 [29, 37] Surgipro 0.8 0.26 0.57 84–110 [23, 2931] Trelex 0.35–0.6 95 [29, 32, 38]
Permanent barrier, non-composite
DUALMESH Biomaterial
0.003/0.022 n/a n/a 1.18 320–420 [7, 29, 39,
41]
MYCROMESH 0.025/0.3 [29, 40]
Permanent barrier, composite
Composix E/X 0.43 183.70 0.89 255.80 [7] Composix L/P 6.07 163.20 0.69 187.40 [7]
Permanent coating
TIMESH
1.24 0.21 16 [30] Extralight
TIMESH Light 1.24 0.29 33 [30]
Resorbable barrier, composite
C-QUR Mesh 0.33 151.2 0.56 321.0 [7] Parietex
3.68 160.20 0.76 155.90 [7] Composite (PCO)
PROCEED 5.46 96.85 0.57 189.50 [7]
(continued)
46
C. R. Deeken and S. P. Lake
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Table 4.4
(continued)
Diameter
Sepramesh IP
Diameter of pores (mm)
Area of pores (mm
of bers
2
(μm)
)
0.40 155.70 0.82 240.60 [
Thickness (mm)
Density (g/
2
m
)
References
Composite Resorbable coating C-QUR Lite
0.34 99.00 0.28 69.19 [ Mesh (≤6in. size mesh)
C-QUR Lite
0.33 151.20 0.46 128.70 [ Mesh (>6in. size mesh)
Reinforced—resorbable bers
ULTRAPRO 2.28 3.45–4.10 102.5 0.44–0.5 28–58 [ VYPRO 3.0 0.34 26 [ VYPRO II 2.6 0.39 40 [
Resorbable synthetic Bare
BIO-A Tissue
33.8 1.57 [22]
Reinforcement TIGR Matrix
1 ~13 ~0.5 [22, 23]
Surgical Mesh VICRYL 13.1 0.07 [22] PHASIX Mesh 0.26 0.51 182 [
Biological tissue-derived Bare
AlloDerm Tissue
n/a n/a n/a 2.02 n/a [64]
Matrix AlloMax
n/a n/a n/a 1.29 n/a [64]
Surgical Graft CollaMend
n/a n/a n/a 1.22 n/a [64]
Implant CollaMend FM
n/a n/a n/a 1.34 n/a [
Implant FlexHD
n/a n/a n/a 1.15 n/a [64]
Acellular Dermis Peri-Guard
n/a n/a n/a 0.47 n/a [
Repair Patch Permacol
n/a n/a n/a 0.91 n/a [64]
Surgical Implant Strattice
n/a n/a n/a 1.76 n/a [64] Reconstructive Tissue Matrix
SurgiMend
n/a n/a n/a 0.84 n/a [64] Collagen Matrix
Surgisis/
n/a n/a n/a 1.37 n/a [64] Biodesign Hernia Grafts
7]
8]
8]
8, 23, 30] 30] 30]
27]
64]
64]