Evaluation methods for mechanical biocompatibility of hernia repair meshes: respective characteristics, application scope and future perspectives

Abstract

Abstract Soft tissue substitutes are subjected to large deformation in\xa0vivo, so the matching of deformation behavior between substitute and tissue is a complex but important criterion for soft tissue repair. Hernia repair mesh is a typical soft tissue substitute, and the mismatch of mechanical properties between mesh and tissues normally leads to decline in the quality of life and hernia recurrence. Therefore, before clinical applications, the evaluation for the mechanical biocompatibility of mesh is particularly important. Currently, several methods have been developed to evaluate mechanical biocompatibility of soft tissue substitutes, including physicomechanical testing, non-invasive measurement, and numerical modeling, etc. However, a comprehensive summary is lacking to provide reference for the selection, implementation and optimization of these methods. In this paper, taking the hernia repair mesh as an example, we systematically review these methods from following aspects: (1) proposing critical issues that need to be paid attention to when performing physicomechanical testing on substitutes, (2) systematically analyzing characteristics and applicable sample types for several typical physicomechanical testing techniques, (3) comprehensively summarizing the advantages and limitations of the main non-invasive measurement methods, and showing the potentials of these methods, (4) emphasizing and dissecting the merits of numerical modeling compared with physicomechanical testing and non-invasive measurement, and proposing the existing and potential improvements of this method. Furthermore, the application scope and future development direction of these methods are proposed. This paper might play an important role in guiding the selection and improvement of evaluation methods for mechanical biocompatibility of soft tissue substitutes.