Biaxial analysis of synthetic scaffolds for hernia repair demonstrates variability in mechanical anisotropy, non-linearity and hysteresis

Background: Over the past 60 years, the soft tissue repair market has grown to include over 50 types of hernia repair materials. Surgeons typically implant these materials in the orientation that provides maximum overlap of the mesh over the defect, with little regard for mechanical properties of the mesh material. If the characteristics of the meshes were better understood, an appropriate material could be identified for each patient, and meshes could be placed to optimize integration with neighboring tissue and avoid the mechanical mis-match that can lead to impaired graft fixation. The purpose of this study was to fully characterize and compare the mechanical properties of thirteen types of hernia repair materials via planar biaxial tensile testing. Methods: Equibiaxial (i.e., equal simultaneous loading in both directions) and strip biaxial (i.e., loading in one direction with the other direction held fixed) tests were utilized as physiologically relevant loading regimes. After applying a 0.1 N pre-load on each arm, samples were subjected to equibiaxial cyclic loading using a triangular waveform to 2.5 mm displacement on each arm at 0.1 Hz for 10 cycles. Samples were then subjected to two strip biaxial tests (using the same cyclic loading protocol), where extension was applied along a single axis with the other axis held fixed. Results: The thirteen evaluated mesh types exhibited a wide range of mechanical properties. Some were nearly isotropic (CQUR (TM), DUALMESH (R), PHYSIOMESH (TM), and PROCEED (R)), while others were highly anisotropic (Ventralight (R) ST, Bard (TM) Mesh, and Bard (TM) Soft Mesh). Some displayed nearly linear behavior (Bard (TM) Mesh), while others were non-linear with a long toe region followed by a sharp rise in tension (INFINIT (R)). These materials are currently utilized in clinical settings as if they are uniform and interchangeable, and clearly this is not the case. The mechanical properties most advantageous for successful hernia repairs are currently only vaguely described in the clinical literature. The characteristics of the human abdominal wall must be extensively characterized to provide a thorough understanding of the tissue being reinforced/replaced by these meshes. A better understanding of these mechanical differences would enable matching of patient characteristics to a specific mesh with the properties best suited to that particular repair. (C) 2014 Elsevier Ltd. All rights reserved.