Supplemental cross-linking in tissue-based surgical implants for abdominal wall repair

BackgroundThere are a number of commercially available tissue-based surgical implants for use in repairing abdominal wall defects. The role and effect of supplemental cross-linking present in some of these implants has been questioned and evaluated in a number of recent experiments. In this review we summarize results of preclinical animal studies evaluating tissue-based surgical implants used for abdominal wall repair with a focus on currently available products and the influence of supplemental cross-linking.MethodsA search of PubMed, MEDLINE and article reference lists was undertaken. Inclusion criteria were animal studies, abdominal wall hernias, and studies reporting on the main outcomes of tensile strength, susceptibility to enzymatic degradation, antigenicity and immunogenicity, foreign body reaction, tissue ingrowth, and complications. Exclusion criteria included those studies that only reported on methods of fixation, implantation or fenestration of mesh.ResultsA total of 21 articles that specifically compared non-cross-linked and supplemental cross-linked tissue-based implants were reviewed. In addition, other studies that compared tissue-based implants, which are not commercially available, were included where appropriate.ConclusionSupplemental cross-linking of collagen found in tissue-based surgical implants has not been shown to adversely affect the strength of the implant or its ability to support long-term ingrowth of tissue. Further studies need to be performed to determine if the differences in cross-linked and non-cross-linked implants observed in animal models translate to differences in clinical performance.