Autologous, cadaveric, and synthetic materials used in sling surgery: Comparative biomechanical analysis

Objectives. To compare the biomechanical properties of allografts, autograf ts, and synthetic materials used in sling surgery using the Instron tensino meter. Methods. The sling grafts we studied consisted of autologous tissues (dermi s, rectus fascia, and vaginal mucosa), cadaver tissues (decellularized derm is and freeze-dried, gamma-irradiated fascia lata), and synthetics (Gore-Te x and polypropylene mesh). The sling grafts were constructed into two types of slings: full strip sling (FSS) versus patch suture sling (PSS). The sli ngs were loaded onto the Instron tensinometer and uniaxially loaded in tens ion until failure. From the load deformation curve, the mechanical properti es of the sling grafts were compared. Results. A total of 140 sling grafts were analyzed. In rank order for the F SSs, cadaver allografts had the strongest tensile strength followed by the synthetics and autologous tissues (P <0.05). The tensile strength of the FS Ss was greater than for the PSSs for all groups (P<less than or equal to>0. 001). In rank order for the PSSs, the synthetics and dermal tissues (autogr aft and allograft) had the highest tensile strength followed by cadaver fas cia lata, rectus fascia, and vaginal mucosa (P <0.05). Conclusions. The tensile strength of the FSS was greater than that of the P SS for the autograft, allograft, and synthetic tissues. The autograft and a llograft tissues were significantly weaker as a PSS. The synthetics were mo re durable as a PSS compared with the organic tissues. When a PSS is constr ucted from autograft and allograft tissues, the risk of suture pull-through and recurrent stress incontinence must be considered. UROLOGY 58: 482-486, 2001. (C) 2001, Elsevier Science Inc.