nant of downstream outcomes.
The bigger question is, how do
surgeons select the best mesh for
each patient?"
In talking to Dr. Badylak, a pio-
neer in his field of regenerative
medicine and tissue engineering,
about the role mesh material
plays in successful hernia repair,
he laments the polypropylene
mindset among surgeons: settling
for the good-but-not-great out-
comes that are predictable of syn-
thetic mesh material — strong
and quickly incorporated 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-
characterized and expected out-
come, 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 undesir-
able effects, but are less frequent-
ly used due to higher cost and
perceived diminishing strength as
the mesh material degrades and
is replaced by host tissue.
While he admits that "there is
