The use of prosthesis in abdominal and thoracic wall defect, 15 year experience: evaluation of tissue reactions and complications.
Synthetic prosthesis (Polypropylene, Dacron and expanded Polyterafluoroethylene) is now widely used in abdominal and thoracic wall reconstructive surgery. Many surgeons have reported great success with various types of prosthetic implants but tissue reactions and other complications have never been well defined. The aim of this study was to determine which molecules react upon tissue contact, which synthetic materials result in less complications and whether some non-specialized prosthetics are correlated with certain types of complications. We studied 54 patients from 1982-1997 who had each been re-operated on for prosthetic complications. Our clinical data was then compared to data collected from animal models. Twenty-one pigs received one or more prosthetic implants: 14 of these pigs received their implants with a "proper surgical technique" while 8 underwent "improper surgical technique". The results from both the clinical and animal study were significantly similar. From a microscopic point of view, we can conclude that different tissues react in the same way with the same or similar types of prostheses. The reactions begin to differ when the thickness and rigidity of the material is considered. A PTFE-polyporpylene combination (Composix Mesh) seems to be the most effective solution, especially in abdominal defect repair which involves peritoneal organ contact. We would also like to emphasize that prosthetic complications can be quite serious and this type of procedure should only be performed by experienced and qualified surgeons.