Biomaterials and abdominal wall
Diaz Elizondo, Jose Antonio
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Becoming a surgeon does not only require skills, but also scientific knowledge regarding the different areas in which interaction takes place. Performing a midline laparotomy incision and the subsequent abdominal wall closure are part of the skills and knowledge that a surgery resident needs to begin mastering at an early stage. All elements that lead to a faulty wound healing process will contribute to an incisional hernia formation. Understanding and knowing the behavior of suture and abdominal wall reconstruction biomaterials, especially after manipulation, is fundamental for selecting the adequate material for the particular tissue and surgical technique. Several suture biomaterials were tested and studied to find changes in biomechanical properties. This study was performed after having the biomaterial undergo a cyclic tension test. A tensile strength test and mathematical models were developed and used. Posteriorly, the study of biomechanical properties of commonly used sutures for abdominal wall fascial closure was made. A swine mode was used to simulate the human abdominal wall. The biomechanical analysis was med in used sutures by general surgery residents with different levels of experience. No statistical difference was found comparing the material or the level of experience. Polydioxanone was identified as the most suitable suture for abdominal wall closure. Several factors have been identified related to the difficulties of surgical skill acquisition. Among them economical and patient safety lead the list. Simulation has become a major element in the active learning process and skill development area. The advantages foreseen by including simulation in a surgical training program are dependent on the validation as a learning instrument of the simulator been used. A high-fidelity simulator validation study was performed confirming that the available learning tool at our Institution complies with construction, programming and measuring capabilities of a valid simulator. Conclusions and perspectives regarding mesh used in abdominal wall reconstruction are presented. Sutures biomaterials and skill development by general surgery specialists are also included.
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