D'Ugo Biomateriali 2008
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D'Ugo Biomateriali 2008






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D'Ugo Biomateriali 2008 D'Ugo Biomateriali 2008 Presentation Transcript

  • Materials for abdominal wall reconstruction: from chemistry to biology Domenico D’UGO Full Professor of Surgery Catholic University - Rome
  • History of Prosthetic Hernia Repair Direct approximation Prostethic repair 2000’s Overwhelming evidence of mesh superiority 1900 Mesh concept Autogenous Graft Fascia Lata Metals Stainless steel Silver Tantalum 1910 1930 Mesh Syntethic filaments of carbon polymer late 50’s PROSTHETIC TENSION-FREE REPAIR Sutured tissue strength late 70’s
  • Monofilamented Polypropylene ( heavyweight ) Marlex ® Monofilamented Polypropylene ( midweight ) Prolene Soft ® Parietene ® Polysoft ® Evolution ® Polypropylene + Poliglecaprone or Polilactic acid ( lightweight / partially absorbable ) Ultrapro ® Evolution of prosthetic materials
  • Inertness Permanence Rapid fibrinous fixation Ideal prosthesis Amid, 1995 Host tissue incorporation 1. 2. 3. 4. Foreign body reaction Fibroblast ingrowth
  • Evolution of prosthetic materials Heavyweight Marlex ® 90 - 95 0.6 - 0.9 Texture Type Examples Weight (g/m 2 ) Pore size (mm) Midweight Prolene Soft ® Parietene ® Polysoft ® Evolution ® 45 - 75 1.5 - 3.0 Lightweight partially absorbable Ultrapro ® 28 - 40 2.0 - 4.0
  • Cobb WS et al. J Surg Res, 2006 Physical features A new concept of “host reaction”
  • Cobb WS et al. J Surg Res, 2006 Physical features A new concept of “host reaction”
  • Heavyweight Midweight Lightweight Native fascia Cobb WS et al., 2006 Physical features Burst load
  • Ideal synthetic mesh: Has it arrived? No contraction Durable tensile strength Hypoallergenic Resistance to infection 1. 2. 3. 4. Effective tissue ingrowth (without excessive inflammation or foreign body reaction) 5. 6. Cost effectiveness Novitsky YW, SAGES 2008 Biocompatibility
  • Proceed ® New solutions for biocompatibility Prolene Soft + PDS + Oxidized Regenerated Cellulose
  • Double layer biocompatible meshes Many products, many manufacturers Mesh Manufacturer Permanent Barrier Parietex Composite TM Covidien Polyester Atelocollagen Type 1, polyethylene glycol, glycerol C-Qur TM Atrium PP Omega-3 fatty acid PROCEED TM Ethicon PP Oxygenated regenerated cellulose + polydioxanone (PDS) Sepramesh TM Davol PP Seprafilm Dualmesh TM Gore PTFE - Surgimesh WN TM Aspide PP Silicone
  • New solutions for biocompatibility Polytetrafluoroethylene (PTFE) Gore Infinit Mesh ®
  • STRENGTH TIME Ideal prosthesis Next level biomaterials reconstruction degradation Bio-Implant Native Fascia Burst Strenght
  • Ideal prosthesis Next level biomaterials
  • 2000’s 1980 138 PubMed items (1980-2000) 272 PubMed items (2000-2008) History of Biomaterials
  • Gaertner B et al, J Gastrointest Surg 2007 Why use Biomaterials ? “ Ideal” for a contaminated field ( infection “tolerant” ) Vascular ingrowth allows for clearance of bacteria
  • … for who ? Infected/exposed mesh Complex recurrence Gaertner B et al, J Gastrointest Surg 2007
  • Biomaterials Physical features Biomaterials PTFE Polypropylene B = Biomaterials P = PTFE F = Fascia B-F P-F B-B F-F
  • Biomaterials Many products, many manufacturers Biomesh Type Products, Manufacturers Human acellular dermis AlloDerm ®, LifeCell Flex HD TM , J&J AlloMax TM , Davol Xenogenic acellular dermis Permacol TM (porcine), Tissue Science Laboratories SurgiMend TM (bovine,calf), TEI Biosciences CollaMend TM (porcine), Davol XenMatriX® (porcine), Brennen Medical LLC; Brennenmed.com Strattice TM , LifeCell Porcine small intestine submucosa Surgisis ®, Cook Medical FortaGen ®, Organogenesis Bovine pericardium Peri-Guard ® and Veritas ®, Synovis Surgical Innovations
  • Alloderm ® Biomaterials Human Cadaver-Derived Più pubblicato, più costoso, di più piccole dimensioni
  • Veritas ® Biomaterials Bovine-Derived
  • Permacol ® Biomaterials Porcine-Derived Surgisis ®
  • Literature Minimal long-term follow-up True prospective data are scarce No published clinical data for many of the biologics on the market
  • Nanotechnology Future perspectives Tissue Engineering Cell adhesion on biomimetic scaffold “ Evolution offer maximum mechanical integrity and stability and mimes the mechanical features of the abdominal wall” Ciardelli G, 2008 Dpt. of Mechanics - Industrial Bioengineering Polytechnic University of Turin
  • Inert, Inactive, Permanent Materials Viable, Cellular, Differentiable Materials Whole Organ Regenerates Bioactive, Conductive, Remodelable Materials Biocomplexity