PURPOSE: Electrospun meshes mimic the extracellular matrix, which may improve their integration. We aimed to compare polycaprolactone (PCL) modified with ureidopyrimidinone (UPy) electrospun meshes with ultra-lightweight polypropylene (PP; Restorelle) reference textile meshes for in vivo compliance. We chose UPy-PCL because we have shown it does not compromise biomechanical properties of native tissue, and because it potentially can be bioactivated. METHODS: We performed ex vivo biomechanical cyclic loading in wet conditions and in vivo overlay of full-thickness abdominal wall defects in rats and rabbits. Animals were sacrificed at 7, 42 and 54 days (rats; n = 6/group) and 30 and 90 days (rabbits; n = 3/group). Outcomes were herniation, mesh degradation and mesh dimensions, explant compliance and histology. High failure rates prompted us to provide additional material strength by increasing fiber diameter and mesh thickness, which was further tested in rabbits as a biomechanically more challenging model. RESULTS: Compliance was tested in animals without herniation. In both species, UPy-PCL-explants were as compliant as native tissue. In rats, PP-explants were stiffer. Contraction was similar in UPy-PCL and PP-explants. However, UPy-PCL-meshes macroscopically degraded from 30 days onwards, coinciding with herniation in up to half of animals. Increased fiber and mesh thickness did not improve outcome. Degradation of UPy-PCL is associated with an abundance of foreign body giant cells until UPy-PCL disappears. CONCLUSION: Abdominal wall reconstruction with electrospun UPy-PCL meshes failed in 50%. Degradation coincided with a transient vigorous foreign body reaction. Non-failing UPy-PCL-explants were as compliant as native tissue. Despite that, the high failure rate forces us to explore electrospun meshes based on other polymers.

Centre for Surgical Technologies Group Biomedical Sciences KU Leuven UZ Herestraat 49 box 7003 3000 Leuven Belgium

Department of Development and Regeneration Woman and Child Group Biomedical Sciences KU Leuven UZ Herestraat 49 box 7003 3000 Leuven Belgium

Department of Urology University Hospitals Leuven UZ Herestraat 49 box 7003 41 3000 Leuven Belgium

INEGI Faculdade de Engenharia da Universidade do Porto Universidade do Porto Rua Dr Roberto Frias 400 4200 465 Porto Portugal

Institute for the Care of Mother and Child 3rd Faculty of Medicine Charles University Podolské nábřeží 157 36 147 00 Prague Czech Republic

Institute of Applied Radiation Chemistry Faculty of Chemistry Technical University of Lodz Stefana Żeromskiego 116 90 924 Lodz Poland

Laboratory of Macromolecular and Organic Chemistry Eindhoven University of Technology P O Box 513 5600 MB Eindhoven the Netherlands

Pelvic Floor Unit University Hospitals KU Leuven UZ Herestraat 49 box 7003 06 3000 Leuven Belgium

SupraPolix BV Horsten 1 5612 AX Eindhoven the Netherlands

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