R. Restrepo1,2, B. Hoagland1, J. Stephenson1,2 1Naval Medical Center Portsmouth,Portsmouth, VA, USA 2Uniformed Services University,Bethesda, MD, USA
Introduction: Congenital defects such as gastroschisis, omphalocele, congenital diaphragmatic hernia, or exstrophy involve a full thickness defect in the abdominal wall that requires a complex surgical approach, and often involve the use of permanent synthetic meshes which cause problems in the long term. An ideal approach to treating these conditions, as well as many acquired hernias or muscular defects, would use a synthetic mesh that serves as a scaffold for the creation of new tissue to fill the gap before the mesh dissolves. Our work with the PLLA nanofiber mesh suggests that it may serve that purpose and lead to a much more elegant method of treating these muscular defects.
Methods: An abdominal wall defect was created in 54 rats (Rattus Norvegicus) followed by implantation of Vicryl (Polygalactin 910), Gortex (Preclude Vessel Guard), or Poly L-lactide (PLLA) Nanofiber mesh in an underlay fashion. The abdominal wall was then harvested at 2, 6, or 12 weeks at which time a portion of the specimen underwent tensile strength testing and histologic processing.
Results: From a strength standpoint, there was no statistical significance between the strength of the Vicryl and PLLA Nanofiber. While there was statistical significance amongst the three meshes at the 6 week endpoint with Gortex being stronger than both the Vicryl (p=0.033) and PLLA Nanofiber (p=0.041), the PLLA actually was stronger at the 12 week point.
Conclusions: This study demonstrated, to our knowledge, the first in vivo comparison of PLLA nanofiber mesh compared to two control meshes currently used in medical practice for repair of hernias and soft tissue defects. The nanofiber mesh compared well with both control meshes and warrants further live tissue testing to further demonstrate potential efficacy in human usage as well as optimize physical and chemical modification parameters of this novel mesh.