ABSTRACT
The use of meshes to repair abdominal wall defects is believed to reduce the overall recurrence rate; however, its presence in the abdominal wall has resulted in short- and long-term complications. The etiology of these complications is, in part, the result of a mismatch in biomechanics that leads to less than optimal biocompatibility. The word biocompatibility is used extensively, yet a great deal of 642uncertainty exists about what it actually means and about the mechanisms that collectively control the concept. The study of mechanobiology holds promise to improve the knowledge base from the molecular to the organ level, whereby mechanical stimulation influences the nature of continuous cellular remodeling to maintain tissues and during the accelerated remodeling process characteristic of the wound healing process. As such, careful examination of the biomechanical environment and the temporal needs of the wound healing process are necessary to illicit a desirable response from a surgically implanted device. Specifically, this investigation reflects on the current state of mesh hernioplasty from a mechanobiology perspective with emphasis on the wound healing process, abdominal wall anatomy and biomechanics, etiology of abdominal wall hernias, biomechanics in the treatment of hernias, and the biomechanical environment of healing wounds. Additionally, a future mesh design concept is presented that takes into consideration the mechanobiology of healing wounds within the abdominal wall.
