The use of synthetic surgical meshes for abdominal hernia repair presents numerous challenges due to insufficient mechanical strength, nonabsorbability, and implant rigidity that leads to complications including chronic inflammatory reactions and adhesions. In this study, a naturally derived, high-strength, flexible, and bioresorbable silk fibroin mesh was developed by knitted textile engineering and biochemical manipulation. The mechanical properties of the mesh were optimized with the trial of different surface coating methods (thermal or chemical treatment) and 12 different knit patterns. Our silk fibroin mesh showed sufficient tensile strength (67.83 N longitudinally and 62.44 N vertically) which afforded the high mechanical strength required for abdominal hernia repair (16 N). Compared to the commonly used commercial nonabsorbable and absorbable synthetic meshes (Prolene mesh and Ultrapro mesh, respectively), the developed silk fibroin mesh showed advantages over other meshes, including lower elongation rate (47.14% longitudinally and 67.15% vertically, p < 0.001), lower stiffness (10–1000 fold lower, p < 0.001), and lower anisotropic behavior (λ = 0.32, p < 0.001). In a rat model of large abdominal hernia repair, our mesh facilitated effective hernia repair with minimal chronic inflammation which gradually decreased from 15 to 60 days postoperation, as well as lower adhesion formation rate and scores compared to control meshes. There was more abundant and organized collagen deposition, together with more pronounced neovascularization in the repaired tissue treated with silk fibroin mesh as compared to that treated with synthetic meshes. Besides, the silk fibroin mesh gradually transferred load-bearing responsibilities to the repaired host tissue as it was bioresorbed after implantation. Its isotropic architecture favored an ease of use during operations. In summary, our findings indicate that the use of knitted silk fibroin mesh provides a safe and effective alternative solution for large abdominal hernia repairs as it overcomes the prevailing limitations associated with synthetic meshes.

中文翻译：

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在大腹部疝气模型中使用高强度，柔性和生物可吸收性丝素蛋白网促进疝气修复。

由于机械强度不足，不可吸收性和植入物刚度不足，导致手术并发症（包括慢性炎症反应和粘连）的原因，使用合成外科网片进行腹部疝气修复面临许多挑战。在这项研究中，通过针织纺织工程和生化处理开发了一种天然来源的，高强度，柔韧和可生物吸收的丝素蛋白网。通过试验不同的表面涂覆方法（热处理或化学处理）和12种不同的编织图案，优化了网眼的机械性能。我们的丝素蛋白网片显示出足够的拉伸强度（纵向67.83 N，垂直62.44 N），提供了腹疝修补所需的高机械强度（16 N）。p <0.001），较低的刚度（较低10-1000倍，p <0.001）和较低的各向异性行为（λ= 0.32，p<0.001）。在大腹部疝气修补的大鼠模型中，我们的网片促进了有效的疝气修补，同时最小化了慢性炎症，慢性炎症从术后15天到60天逐渐减少，并且与对照组相比，其粘连形成率和得分更低。与合成网眼相比，用丝素蛋白网眼处理的修复组织中胶原蛋白沉积更为丰富和有组织，并且新血管形成更加明显。此外，丝素蛋白网布在植入后被生物吸收后，逐渐将负荷承担的责任转移到了修复后的宿主组织上。它的各向同性架构有利于操作过程中的易用性。总之，