the problems associated with permanent synthetic mesh, including
chronic inflammation and foreign body reaction, stiffness and fibrosis,
and mesh infection. Studies have shown that the risk of wound com-
plications is unreasonably high when permanent synthetic mesh is
placed in contaminated fields. Cavallaro et al., argued that biologic
mesh should be used in contaminated fields because 50% to 90% of
synthetic meshes placed in that setting required removal.
"I'm an evidence man," says Dr. Snyder. "Except where there's
already an infection, to me there's no compelling evidence that biolog-
ics would be better or more useful than synthetics."
Biosynthetics: a new class of hernia mesh
Due to the moderate durability and substantial cost of biologics, mesh
made of biodegradable polymers instead of animal or cadaver tissue
is gaining in popularity. Biosynthetic or resorbable synthetic mesh has
become more widely used for large ventral hernia repair and abdomi-
nal wall reconstruction, says Bruce Ramshaw, MD, FACS, the co-
director of Advanced Hernia Solutions and chairman and chief med-
ical officer of Surgical Momentum.
"Similar to the biologics, resorbable synthetic meshes are designed
to provide mechanical strength as well as a temporary scaffold struc-
ture for tissue ingrowth during the critical period of wound healing,"
says Dr. Ramshaw. "Unlike biologic mesh, resorbable synthetics have
relatively predictable mechanical properties, including compliance,
elasticity, strength and fracture, as well as rate of absorption and
degradation." OSM
E-mail doconnor@outpatientsurgery.net.
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