Synthetic surgical mesh has become an important tool in the armamentarium of the surgeon reconstructing soft tissue defects and hernias. Mechanical failure and recurrence remain primary causes of repair revision and mesh removal in hernia repair. This study evaluated the qualitative and quantitative morphology of intramesh fibrous connective tissue (FCT) healing in a range of clinically used knitted (polypropylene and polyester) and non-woven (polypropylene) barrier and non-barrier surgical meshes implanted in a rabbit model. The results demonstrated that the knitted mesh displayed intramesh FCT healing that was concentric to the mesh fibers with significant between fiber FCT discontinuities due to the presence of adipose tissue. Non-woven surgical mesh resulted in a more linearly oriented intramesh FCT healing, primarily parallel to the plane of the non-woven mesh, with minimal FCT discontinuity. Non-woven surgical mesh had a significantly reduced incidence of FCT discontinuity and a higher probability of a FCT response than knitted surgical mesh. The presence of significant discontinuities in intramesh FCT healing in this study, especially in lightweight knitted surgical mesh which has been associated with mechanical failures clinically, underscores the importance of complete FCT healing for secure long term hernia repair. In conclusion, non-woven monofilament constructions of barrier and non-barrier surgical mesh resulted in highly congruent intramesh FCT healing when compared to commonly used barrier and non-barrier knitted surgical mesh constructions which demonstrated significant FCT healing discontinuities.
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