Biomesh (or biologic mesh) is a type of

surgical mesh Surgical mesh is a loosely woven sheet which is used as either a permanent or temporary support for organs and other tissues during surgery. Surgical mesh is created from both inorganic and biological materials and is used in a variety of surg ...

made from an organic

biomaterial A biomaterial is a substance that has been engineered to interact with biological systems for a medical purpose, either a therapeutic (treat, augment, repair, or replace a tissue function of the body) or a diagnostic one. As a science, biomateria ...

(such as

porcine The pig (''Sus domesticus''), often called swine, hog, or domestic pig when distinguishing from other members of the genus '' Sus'', is an omnivorous, domesticated, even-toed, hoofed mammal. It is variously considered a subspecies of ''Sus s ...

dermis, porcine small intestine submucosa,

bovine Bovines (subfamily Bovinae) comprise a diverse group of 10 genera of medium to large-sized ungulates, including cattle, bison, African buffalo, water buffalos, and the four-horned and spiral-horned antelopes. The evolutionary relationship betwee ...

dermis or

pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...

, and the

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

fascia lata The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular septu ...

of a cadaveric human). Biologic mesh is primarily indicated for several types of

hernia A hernia is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the gr ...

repair, including inguinal and

ventral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek language, Greek roots, describe something in its standard anatomical position. Th ...

hernias, hernia prophylaxis, and contaminated hernia repairs. However, it has also been used in

pelvic floor dysfunction Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects ...

parotidectomy A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells ...

, and

reconstructive plastic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...

. The development of biologic mesh largely has derived from the need of a

biocompatible Biocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation. The ambiguity of the term reflects the ongoing de ...

material that addresses "the problems associated with a permanent synthetic mesh, including chronic inflammation, foreign body reaction, fibrosis, and mesh infection." , however, the efficacy and optimal use of biological mesh products remains in question.

Development, benefits, and drawbacks

The idea of using organic materials for surgical mesh has been around since at least the late 1950s, though researchers soon learned the materials they tested weren't

. Research into more compatible

s occurred in the proceeding decades, including the search for cellular-based materials extracted from humans and animals. For example, in 1980, research presented at the first ever World Biomaterials Congress detailed the examined use of dermal collagen of sheep to construct biological mesh for reconstructive surgery. Since then, "research for developing and improvising the biological material required for the production of these meshes" has been ongoing. Typical advantages attributed to biologic meshes include a reduced risk of infection compared to synthetic meshes, and the absorption of the mesh into the resulting scar as part of cellular ingrowth. Commonly described drawbacks include the high cost of the material and its uncertain clinical effectiveness, particularly when the high cost is considered. An August 2015 literature review published by the

Canadian Agency for Drugs and Technologies in Health The Canadian Agency for Drugs and Technologies in Health, or CADTH, is a Canadian national organisation that provides research and analysis to healthcare decision-makers. The organisation was established in 1989 by the country's federal governme ...

addressed these drawbacks, concluding that "there remains a lack of sufficient evidence to guide clinical practice regarding the use of biological mesh products... Further rigorously designed RCTs are required to clarify comparative clinical effectiveness and safety of the many available biological mesh products for most surgical indications in which their use has been suggested."

Contamination considerations

The presence of contamination may limit the applicability of permanent synthetic mesh in some procedures such as hernia repair. Biologic mesh may be acceptable for this purpose or for placement in open wounds as a staged closure in complex abdominal wall reconstruction. There is limited data in both of these areas, with some noting a high risk of hernia recurrence and associated infection. The data is mostly limited to animal models and case series.Harth KC, Rosen MJ. Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction. Surg Innov. 2009 Dec;16(4):324-9. However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.

References

{{Reflist, colwidth=30em Biomaterials Implants (medicine)