In vitro characterisation of the erosion of soft tissues by surgical mesh

Abstract Surgical mesh is used widely in operations to treat hernias, prolapsed organs, urinary incontinence, etc. A major complication following surgery is so-called “mesh erosion”, in which the mesh material rubs on adjacent soft tissue, causing it to wear away. Mesh erosion is the subject of a large body of clinical case histories, but there is no literature reporting in vitro laboratory experiments to investigate this phenomenon. In this paper we describe a preliminary study to generate and measure the erosion of soft tissue (porcine muscle) by a surgical mesh material (knitted polypropylene fibres). We found significant differences in the rate of erosion depending on the applied force and the direction of loading and on the presence or absence of connective tissue (perimysium). Two different methods of making the edge of the mesh sample gave similar erosion rates: this may be due to changes in the nature of the edge during erosion. Overall the rates measured were consistent with the clinical experience that mesh can erode completely through the walls of organs such as the bladder and vagina in a few weeks or months. In our opinion, the phenomenon of mesh erosion should be more extensively investigated and different mesh products characterised in order to prevent future clinical complications.