Fiber-reinforced dermis graft for ventral hernia repair.

Abstract

Ventral hernia repair (VHR) continues to be a challenge for surgeons. Poor long-term durability of the commonly-used human acellular dermal matrix (HADM) grafts often results in VHR failure and reherniation. We hypothesized that fiber-reinforcement will improve the mechanical properties of HADM grafts and maintain these properties after enzymatic degradation. We designed a reinforced HADM (r-HADM) graft comprised of HADM and a small amount (~10wt% or 56g/m(2)) of 2-0 monofilament polypropylene. We evaluated the failure and fatigue biomechanics of r-HADM grafts and HADM controls, before and after 8h of in vitro enzymatic degradation, in ball-burst and planar biaxial testing modes (n=6-11/group/test). Fiber-reinforcement improved time-zero failure properties of HADM. While enzymatic degradation resulted in a significant reduction in nearly all mechanical properties and frequent premature failure of HADM, key sub-failure parameters and cyclic dilatational strain were maintained in r-HADM, with no sample having premature failure. These data show that fiber-reinforcement improves biomechanical properties and imparts mechanical durability to r-HADM during enzymatic degradation. Our findings suggest that fiber-reinforcement may be a strategy to mitigate the loss of HADM graft mechanical properties after in vivo implantation, and thereby limit VHR bulging and improve outcomes.