Biomesh

Biologic mesh originates from the need of a material addressing the problems associated with permanent synthetic mesh, including chronic inflammation and foreign body reaction, stiffness and fibrosis, and mesh infection. It is sometimes made of human or animal dermis or porcine small intestinal submucosa. Data on biologic mesh comprises mainly animal studies and small series evidence.

Indications

The theoretical advantage of biologic mesh over synthetic mesh has appealed to surgeons. Over the last decade, surgeons have utilized biologic mesh in a variety of cases ranging from primary ventral and inguinal hernia repair in non-infected fields, recurrent hernias, reinforced hernia repair, hernia prophylaxis, and the most widely used application, hernia repair in the contaminated or potentially contaminated field.

Contaminated Setting

The presence of contamination may limit the applicability of permanent synthetic mesh in some hernia repairs. 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. However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.