Mesh deformation: A mechanism underlying polypropylene prolapse mesh complications in vivo.
Mesh deformation: A mechanism underlying polypropylene prolapse mesh complications in vivo.
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DOI：
10.1016/j.actbio.2022.05.051
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发表时间：
2022-08
影响因子：
9.7
通讯作者：
Moalli, Pamela A.
中科院分区：
文献类型：
--
作者：
Knight, Katrina M.;King, Gabrielle E.;Palcsey, Stacy L.;Suda, Amanda;Liang, Rui;Moalli, Pamela A.
用于盆腔器官脱垂（POP）修复的聚丙烯补片受到并发症的阻碍。大多数POP补片在体外拉伸后高度不稳定，表现为显著变形（孔隙塌陷和褶皱），导致结构特性和材料负荷改变。通过故意将塌陷的孔隙和褶皱引入通常具有开放孔隙并且在植入后保持相对平坦的补片中，我们在体内再现了补片并发症。为此，将补片以非变形（扁平）与变形（孔塌陷+/−皱纹）构型植入恒河猴阴道，并置于张力下。12周后，补片变形的动物出现两种并发症，1）补片通过阴道上皮暴露，2）肌成纤维细胞增殖伴纤维化-疼痛机制。对变形补片的总体反应是阴道变薄，与细胞凋亡加速、胶原蛋白含量减少、蛋白质水解增加、机械完整性恶化以及与应力屏蔽一致的收缩功能丧失（补片暴露的前兆）相关。然而，观察到区域差异，一些区域显示肌成纤维细胞增殖和基质沉积。变形网格施加的可变机械提示可能会引起这两种不同的反应。使用与阴道上的均匀应力相关的补片，通过在张紧后保持平坦并具有开放的孔隙，对于改善结局至关重要。
Polypropylene meshes used in pelvic organ prolapse (POP) repair are hampered by complications. Most POP meshes are highly unstable after tensioning ex vivo, as evidenced by marked deformations (pore collapse and wrinkling) that result in altered structural properties and material burden. By intentionally introducing collapsed pores and wrinkles into a mesh that normally has open pores and remains relatively flat after implantation, we reproduce mesh complications in vivo. To do this, meshes were implanted onto the vagina of rhesus macaques in nondeformed (flat) vs deformed (pore collapse +/− wrinkles) configurations and placed on tension. Twelve weeks later, animals with deformed meshes had two complications, 1) mesh exposure through the vaginal epithelium, and 2) myofibroblast proliferation with fibrosis – a mechanism of pain. The overarching response to deformed mesh was vaginal thinning associated with accelerated apoptosis, reduced collagen content, increased proteolysis, deterioration of mechanical integrity, and loss of contractile function consistent with stress shielding – a precursor to mesh exposure. Regional differences were observed, however, with some areas demonstrating myofibroblast proliferation and matrix deposition. Variable mechanical cues imposed by deformed meshes likely induce these two disparate responses. Utilizing meshes associated with uniform stresses on the vagina by remaining flat with open pores after tensioning is critical to improving outcomes.
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影响因子：
4.6
作者：
Bankhead P;Loughrey MB;Fernández JA;Dombrowski Y;McArt DG;Dunne PD;McQuaid S;Gray RT;Murray LJ;Coleman HG;James JA;Salto-Tellez M;Hamilton PW
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作者：
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通讯作者：
Cosson, M.
影响因子：
2.2
作者：
Klinge, U;Klosterhalfen, B;Schumpelick, V
通讯作者：
Schumpelick, V