Pros and cons of different types: get a grip on pelvic reconstructive grafts.(Gynecology)

BALTIMORE -- Support is literally the operative word in pelvic reconstructive surgery, and choosing the right graft, if any, is an important consideration.

Sacropexies and slings are procedures that traditionally require a graft to establish pelvic support. However, grafts have also been proposed as enhancements for other procedures, Dr. Victoria Handa said at a urogynecology meeting sponsored by Johns Hopkins University.

"I think we are still struggling to see how grafts can enhance the surgeries we do, such as anterior and posterior repair." said Dr. Handa, a member of the female pelvic medicine and reconstructive surgery department at the university.

The most common synthetic grafts used in reconstructive gynecology are made of polypropylene, polyester, polytetrafluoroethylene, or absorbable materials such as Vicryl or Dexon. Potential complications from these grafts include extrusion; erosion; exposure; intestinal adhesions; fistulas; and seromas or infections related to permanent graft materials. These complications are not limited to pelvic reconstruction; they are the same problems seen when grafts are used in other surgeries such as vascular grafts, hernia repair, and orthopedic procedures.

One of the most important properties of synthetic grafts is the pore size, since this determines the amount of tissue ingrowth that occurs after surgery. Grafts with large pores will have more ingrowth, while Gore-Tex and other similar materials with micropores are more likely to become encapsulated. Small pores can increase the risk for infection, and the attachments to surrounding tissues may be weaker because there is less ingrowth.

Grafts with larger pores are more difficult to remove. "Taking a Prolene mesh out is like taking gum out of your hair," Dr. Handa noted.

Fiber type--monofilament or multifilament--is another consideration when selecting a synthetic graft material. A multifilament graft has some of the characteristics of grafts with a small pore size, but it is more pliable, which makes it a strong candidate for use near the vagina, Dr. Handa said.