Hernia Materials: Fundamentals of Prosthetic Characteristics

Abstract

Hernia repair materials have advanced over the past 80 years to include over 150 designs at present. The Deeken & Lake Mesh Classification System was created to unify the terminology used to describe these biomaterials and provide insight into the nuances of the various designs. Meshes are classified in a hierarchical fashion, grouped first by the composition of the structural mesh component, and second by the presence of a barrier, coating, or reinforcing material. In addition to composition, surgeons must also understand the physical and mechanical properties associated with these materials in order to inform mesh selection. A series of prior publications are summarized which report the physical and mechanical properties of over 50 biomaterials commonly utilized for hernia repair. Many of these biomaterials meet or exceed the threshold values previously recommended by our group: suture retention and tear resistance strength >20 N and ball burst strength >50 N/cm, with strain in the range of 10–30%; however, it remains unclear whether these characteristics match the properties of the human abdominal wallHuman abdominal wall as the mechanics of abdominal tissues and hernia biomaterials are incompletely understood. It is unlikely that any single biomaterial design encompasses all of the ideal physical and mechanical characteristics required to fully match the properties of the human abdominal wall. A complete set of target guidelines including strength, compliance, anisotropy, nonlinearity, and hysteresis should be established through continued testing of human abdominal wall tissue specimens and through sophisticated and well-informed modeling efforts.