Page 60 - Read Online

Page 6 of 9 Alimi et al. Plast Aesthet Res 2020;7:5 I http://dx.doi.org/10.20517/2347-9264.2019.39

Table 3. Sample of synthetic mesh products by manufacture [24]
Synthetic mesh product name Manufacture
Prolene Boston Scientific
Parietex Medtronic
Polutetrafluoroethylene W. L. Gore & Associates
Seri Sofregen Medical Inc.
Marlex CR Bard
Sepramesh CR Bard
Proceed Ethicon
ProGrip Medtronic
Prolite Atrium Medical Corp.

Table 4. Ventral hernia working group classification system for surgical site occurrence risk [22]
VHWG Grade Characteristics
1. Low risk Low risk of complications
No history of wound infections
2. Co-morbid Smoker
Obese
Diabetic
Immunosuppressed
COPD
3. Potentially contaminated Previous wound infection
Stoma present
Violation of the gastrointestinal tract
4. Infected Infected mesh
Septic dehiscence
VHWG: Ventral Hernia Working Group; COPD: chronic obstructive pulmonary disease

In 2010, the VHWG developed a grading system for surgeons to use to determine the complexity of the
case with regards to risk of surgical site occurrence (SSO). At that time, this novel grading system created a
framework by which a surgeon could assess the risk of SSO based on both the patient’s comorbidities and
the characteristics of the hernia to be repaired . While this grading system does not take into account the
[22]
size of the hernia defect or if the defect is the result of a recurrence, it created a uniform system by which
to categorize wounds based on their SSO risk and provided recommendations as to which mesh types may
[22]
be appropriate based on these categories of risk [Table 4] . With this grading system in mind, the VHWG
recommends the use of a prosthetic reinforcement material in the case of all incisional/ventral hernias
[22]
regardless of whether the midline fascia is reapproximated or not . The working group concludes that
synthetic mesh should be used in hernias without gross contamination, or Grade 1 categorized patients.
[15]
In Sosin et al.’s review, there were notable differences in complications, infections, and the formation
of seroma/hematoma in the placement of synthetic mesh in varying planes, as described in Table 5.
Recurrence rates and occurrence of mesh removal were statistically similar regardless of mesh plane.

Biologic mesh
Biologic mesh development occurred because of the need for a material that was believed to heal by tissue
ingrowth as opposed to scar formation and encapsulation, which potentially would allow its utilization
in an infected or contaminated field. Products on the market are in general created with a decellularized
human, porcine, or bovine scaffold, whether dermis, pericardium, or intestinal mucosa. The extracellular
collagen matrix is thought to encourage incorporation of the surrounding tissue by ingrowth of the
[23]
fibrocollagenous tissue and blood vessels . Table 6 lists the most commonly used biologic meshes
currently on the market . While many of the meshes perform in a similar manner, the unique qualities
[24]
within these meshes include some chemical modifications to create cross-links in the collagen fibers, while
others are xenogenic, and some are allogenic. Some have reported that the cross-linking nature of the
meshes help to prevent degradation and increase the durability of the product and the repair; however, they