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Reconstructive materials used in surgery: Classification and host response

Emanuel C Trabuco, MD, MS
John B Gebhart, MD, MS
Section Editors
Linda Brubaker, MD, FACOG
Hilary Sanfey, MD
Charles E Butler, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


This topic review will discuss the classification and histologic behavior of reconstructive materials used in surgery. Prosthetic materials in the surgical management of specific conditions are discussed in individual topic reviews.


Hernia repair — The use of prosthetic material dramatically reduces the incidence of recurrence associated with ventral, inguinal, and femoral hernia repair. Polypropylene is the most common material used. (See "Overview of treatment for inguinal and femoral hernia in adults" and "Overview of abdominal wall hernias in adults".)

Pelvic organ prolapse — Pelvic organ prolapse (POP) and urinary incontinence are common, comorbid disorders in women, and can greatly impact quality of life [1]. (See "Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management".)


The four kinds of surgical reconstructive materials differ by source: synthetic mesh, autografts, allografts, and xenografts. Advantages and disadvantages of the different material types are found in the table (table 1).

Synthetic materials — Synthetic materials are available as both absorbable (eg, polygalactin 910 [Vicryl], polyglycolic acid [Dexon]) and nonabsorbable mesh (eg, polypropylene [Marlex, Prolene], and expanded polytetrafluoroethylene [ePTFE, Gore-tex]). Compared with biologic grafts, advantages of synthetic materials include greater availability (does not require harvesting) and lower cost of material. However, infectious and erosion complications, especially with transvaginal surgery, have prompted a search for alternative materials [2]. (See 'Host response' below.)

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Literature review current through: Sep 2017. | This topic last updated: Aug 15, 2017.
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  1. Helström L, Nilsson B. Impact of vaginal surgery on sexuality and quality of life in women with urinary incontinence or genital descensus. Acta Obstet Gynecol Scand 2005; 84:79.
  2. Huebner M, Hsu Y, Fenner DE. The use of graft materials in vaginal pelvic floor surgery. Int J Gynaecol Obstet 2006; 92:279.
  3. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007; 356:2143.
  4. Walter AJ, Hentz JG, Magrina JF, Cornella JL. Harvesting autologous fascia lata for pelvic reconstructive surgery: techniques and morbidity. Am J Obstet Gynecol 2001; 185:1354.
  5. Trabuco EC, Klingele CJ, Gebhart JB. Xenograft use in reconstructive pelvic surgery: a review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:555.
  6. Cundiff GW, Varner E, Visco AG, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol 2008; 199:688.e1.
  7. Trabuco EC, Zobitz ME, Klingele CJ, Gebhart JB. Effect of host response (incorporation, encapsulation, mixed incorporation and encapsulation, or resorption) on the tensile strength of graft-reinforced repair in the rat ventral hernia model. Am J Obstet Gynecol 2007; 197:638.e1.
  8. Klinge U, Klosterhalfen B, Müller M, Schumpelick V. Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 1999; 165:665.
  9. Klinge U, Schumpelick V, Klosterhalfen B. Functional assessment and tissue response of short- and long-term absorbable surgical meshes. Biomaterials 2001; 22:1415.
  10. Chen CC, Ridgeway B, Paraiso MF. Biologic grafts and synthetic meshes in pelvic reconstructive surgery. Clin Obstet Gynecol 2007; 50:383.
  11. Barbolt TA. Biology of polypropylene/polyglactin 910 grafts. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 Suppl 1:S26.
  12. Bellón JM, Rodríguez M, García-Honduvilla N, et al. Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes. Am J Surg 2007; 194:68.
  13. Achtari C, Hiscock R, O'Reilly BA, et al. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:389.
  14. Iglesia CB, Fenner DE, Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8:105.
  15. Falagas ME, Velakoulis S, Iavazzo C, Athanasiou S. Mesh-related infections after pelvic organ prolapse repair surgery. Eur J Obstet Gynecol Reprod Biol 2007; 134:147.
  16. White, RA. The effect of porosity and biomaterial on the healing and long-term mechanical properties of vascular prostheses. ASAIO J 1988; 11:95.
  17. Bobyn JD, Wilson GJ, MacGregor DC, et al. Effect of pore size on the peel strength of attachment of fibrous tissue to porous-surfaced implants. J Biomed Mater Res 1982; 16:571.
  18. Cobb WS, Burns JM, Peindl RD, et al. Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 2006; 136:1.
  19. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1997; 1:15.
  20. Baessler K, Hewson AD, Tunn R, et al. Severe mesh complications following intravaginal slingplasty. Obstet Gynecol 2005; 106:713.
  21. Fitzgerald MP, Mollenhauer J, Brubaker L. The antigenicity of fascia lata allografts. BJU Int 2000; 86:826.
  22. Lemer ML, Chaikin DC, Blaivas JG. Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn 1999; 18:497.
  23. Huang YH, Lin AT, Chen KK, et al. High failure rate using allograft fascia lata in pubovaginal sling surgery for female stress urinary incontinence. Urology 2001; 58:943.
  24. McBride AW, Ellerkmann RM, Bent AE, Melick CF. Comparison of long-term outcomes of autologous fascia lata slings with Suspend Tutoplast fascia lata allograft slings for stress incontinence. Am J Obstet Gynecol 2005; 192:1677.
  25. Culligan PJ, Blackwell L, Goldsmith LJ, et al. A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol 2005; 106:29.
  26. Gandhi S, Goldberg RP, Kwon C, et al. A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse. Am J Obstet Gynecol 2005; 192:1649.
  27. Ward RM, Sung VW, Clemons JL, Myers DL. Vaginal paravaginal repair with an AlloDerm graft: Long-term outcomes. Am J Obstet Gynecol 2007; 197:670.e1.
  28. Gandhi S, Kubba LM, Abramov Y, et al. Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings. Am J Obstet Gynecol 2005; 192:1643.
  29. Altman D, Zetterström J, López A, et al. Functional and anatomic outcome after transvaginal rectocele repair using collagen mesh: a prospective study. Dis Colon Rectum 2005; 48:1233.
  30. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996; 7:81.