The Synthetic Scaffolds for Ventral Hernia Repair: Perspectives for Regenerative Surgery—Systematic Review

Ventral hernia (VH) frequently affects patients after abdominal surgery. The use of a mesh is often recommended. Different materials are described, from synthetic non-resorbable meshes to biological meshes. New generation meshes, also named scaffolds, aim to combine the advantages of both materials. The aim of this review is to provide an overview of the cytological, histological, biomechanical, and clinical outcomes of the use of the newest resorbable synthetic scaffolds in VH repair, based on experimental studies in a pre-clinical setting. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. Only experimental studies were included. Outcome parameters were building technique, in vitro cytocompatibility, in vivo histocompatibility, biomechanical analysis, and clinical outcomes. The articles included were nine. The total number of cases treated was 257. Materials analyzed included electrospun silk fibroin (SF)/poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) hybrid scaffolds, biodegradable polyester poly-ε-caprolactone (PCL) in the form of nanofibers, biodegradable mesh in poly-4-hydroxybutyrate (P4HB), nanofibrous polylactic acid (PLA) scaffold with a polypropylene (PP) material to generate a sandwich-like mesh, the collagen sponge (CS) group, the hybrid scaffold (HS) containing CS and poly-L-lactide (PLLA), and the hybrid scaffold (HS) + bone marrow (HSBM). Resorbable synthetic scaffolds are new, safe, surgical materials for the treatment or prevention of ventral hernia in animal models. Scaffolds should be tested in a contaminated surgical field for emergency use. Rigorous schematic indications for data collection are needed to improve the quality of the data in order to definitively clarify the pathway involved in inflammatory induced response.

Syndecan-4 Functionalization of Tissue Regeneration Scaffolds Improves Interaction with Endothelial Progenitor Cells

Key to most implanted cell free scaffolds for tissue regeneration is the ability to sequester and retain undifferentiated mesenchymal stem cells at the repair site. In this report, syndecan-4, a heparan sulfate containing proteoglycan, was investigated as a unique molecule for use in scaffold functionalization. An electrospun hybrid scaffold comprised of poly (glycerol) sebacate (PGS), silk fibroin and type I collagen (PFC) was used as a model scaffold to develop a procedure and test the hypothesis that functionalization would result in increased scaffold binding of endothelial progenitor cells (EPCs). For these studies both Syndecan-4 and stromal derived factor-1α (SDF-1α) were used in functionalization PFC. Syndecan-4 functionalized PFC bound 4.8 fold more SDF-1α compared to nonfunctionalized PFC. Binding was specific as determined by heparin displacement studies. After culture for 7 days, significantly, more EPCs were detected on PFC scaffolds having both syndecan-4 and SDF-1α compared to scaffolds of PFC with only syndecan-4, or PFC adsorbed with SDF-1α, or PFC alone. Taken together, this study demonstrates that EPCs can be bound to and significantly expanded on PFC material through syndecan-4 mediated growth factor binding. Syndecan-4 with a multiplicity of binding sites has the potential to functionalize and expand stem cells on a variety of scaffold materials for use in tissue regeneration.