Institute for Regenerative Medicine.
"There is no biomaterial, regardless of what it's made of, that is
inert. Nothing is inert," he says. "Everything that you put into the
body elicits some type of a response. The question is, is it a favorable
or a non-favorable response? The host's response to the material is
the primary determinant of success. The choice of the most appropri-
ate surgical mesh for each individual patient is the primary determi-
nant of downstream outcomes. The bigger question is, how do sur-
geons select the best mesh for each patient?"
In talking to Dr. Badylak, a pioneer in his field of regenerative medi-
cine and tissue engineering, about the role mesh material plays in suc-
cessful hernia repair, he laments the polypropylene mindset among
surgeons: settling for the good-but-not-great outcomes that are pre-
dictable of synthetic mesh material — strong and quickly incorporat-
ed into host tissue — yet eliciting a pro-inflammatory immune
response that leads to scar tissue and such resulting complications as
pain, infection and recurrence.
"Polypropylene has been used for so long, and has such a well-char-
acterized and expected outcome, that it's always going to be used," he
says. "We know that we're going to get a foreign body response, we
know we're going to get scar tissue formation, and it's going to get
socked into the tissue there. Surgeons have come to not only expect
that, but in some cases desire that. It's an acceptable outcome, but
basically you have a scar plate where the surgical mesh was placed."
Dr. Badylak also finds fault with biologically derived mesh. Yes,
mesh made of extracellular matrix materials can reduce some of
polypropylene's undesirable effects, but are less frequently used due
to higher cost and perceived diminishing strength as the mesh materi-
al degrades and is replaced by host tissue.
While he admits that "there is no such thing as a perfect surgical
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