The behavior of different types of polytetrafluoroethylene (PTFE) prostheses in the reparative scarring process of abdominal wall defects

Abstract

Currently one of the most widely used prosthetic materials in the repair of abdominal wall defects, is expanded polytetrafluoroethylene (ePTFE). It has been suggested that its behavior with respect to the reparative process may depend on its structure. The aim of the present study was to evaluate the effect of the structure of 3 ePTFE prostheses on the scarring process in an abdominal-wall-defect experimental model. The prostheses employed were the Soft Tissue Patch (STP) which is laminar in structure, Mycro Mesh (MM) which is multilaminar with perforations, and the Dual Mesh (DM) prosthesis which has one non-porous surface. Abdominal wall defects (7x5cm) were created in 36 New Zealand rabbits and repaired using fragments of STP, MM and DM. Follow-up periods were 14, 30, 60 and 90 days post-implant. At these times prostheses were macroscopically examined for the presence of infection andlor rejection and the formation of adhesians to abdominal viscera. Specimens were also taken for microscopic analysis (optical and scanning electron) and for immunohistochemical analysis using the rabbit macrophage-specific monoclonal antibody RAM-11. Labelled macrophage counts were performed at each follow-up session. No cases of infection or rejection were found. Loose adhesions between prosthesis and underlying viscera were observed in 2 of the STP, 4 of the MM and 2 of the DM implants. STP and DM implants were progressively encapsulated by organized connective tissue on both peritoneal and subcutaneous surfaces. Cellular colonization was observed on both STP surfaces and on the porous surface of the DM although no more than a third of the biomaterial was penetrated by cells in either case. Colonization was very slight at prosthesis anchorage points. MM implants differed only in the formation of connective tissue bridges in perforated areas, and cellular infiltration in interlaminar spaces. Macrophage response was similar in Offprint requests 10: Prof. J. Buján, Department of Morphological Sciences and Surgery, Faculty of Medicine, University of Alcalá de Henares, Crta. Madrid-Barcelona, km 33.600, 28871 -Alcalá de Henares, Madrid, Spain the 3 prostheses with a reduction in RAM-11 labelled cells (p<0.05) between 14 and 90 days post-implant. We conclude: a) the 3 types of PTFE prosthesis induced low incidence of adhesion formation between biomaterial and viscera; b) integration mechanisms of the 3 prostheses were similar and culminated with the encapsulation of the PTFE by the neoformed tissue; c) the macrophage response induced by the 3 prostheses was similar to that of any reparative process in the absence of biomaterial.