A new universal pore measurement and clustering approach for surgical meshes

The pore structure and pore size is a crucial characteristic of surgical meshes. A huge amount of different approaches for mesh classification based on pore size or materials are available. It is difficult to use these classification methods because of the large variety in knitting structures and pore shapes. No agreement on an established method to measure the pore size is available despite the fact that the surgical community agrees that pore size and geometry are crucial factors for the result of a hernia repair. In this publication a new approach to characterize meshes based on their pore shape and pore size is presented. The pore size is defined by the largest inscribed circle within a mesh pore and the smallest circumscribed circle outside the pore, in addition to hence calculated values. This allows a characterization with regards to tissue ingrowth and bridging behavior. The measurements are made using the scientific image processing software ImageJ and additional customized software plug-in. Since the program ImageJ is public domain and the plug-ins are available, the measurements can be reproduced. Furthermore, the presented pore descriptions can also be used for manual pore size verification.