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简体中文Mesh Fixation — Tackers, Sutures and Adhesives
Mesh fixation is how an implanted surgical mesh is held in position while tissue integration occurs. Three families are in general use: mechanical fixation with tacks delivered by a tacker, suture fixation, and adhesive fixation. Some repairs use no fixation at all.
Why it matters
Fixation is a separate decision from the choice of mesh, and the two are routinely discussed as one. A mesh is selected on its construction; fixation is selected on how the mesh is to be held, by what, and whether that something is intended to remain. Keeping the decisions apart is what makes either of them legible.
Three families, and none
Mesh fixation divides into mechanical fixation with delivered tacks, fixation with sutures placed by hand, and adhesive fixation. A fourth option is to use none: some repairs are performed without fixation, and whether fixation is required is a judgement about the repair rather than a property of the mesh.
The three families differ in mechanism before they differ in anything else. Tacks and sutures pass a physical element through tissue; an adhesive does not. That is the structural distinction, and most of what is said about fixation follows from it.
The device and the element are different products
A tacker is an instrument that delivers tacks. The tacks are the fixation elements. They are specified separately, they are regulated separately, and conflating them makes both harder to reason about — particularly around what remains in the body, which is a property of the tack and not of the tacker.
Tacks come in absorbable and permanent forms. An absorbable tack is made from a polymer that is resorbed after implantation, so the fixation element does not remain indefinitely; a permanent tack does. What remains, and over what period, is a product specification and belongs in the instructions for use rather than here.
The tack’s form matters mechanically. A helical tack engages tissue as it is rotated in, which is a different action from a clip-like element being driven. Both are mechanical fixation; they are not the same mechanism.
Compatibility is stated, not assumed
Whether a given fixation device is intended for use with a given mesh is stated in the instructions for use for both products. It is not something to infer from the fact that both are implantable and both are used in the same operation.
This matters more for composite meshes than for plain knits, because a dual-sided construction has a defined orientation and a face that is intended toward a particular tissue. A fixation element passes through the sheet, and whether that is intended is part of what the controlled documents specify.
Fixation is, in the end, a separate decision from the mesh. The mesh is selected on how it is built; the fixation on how the mesh is to be held, by what, and whether that something is meant to still be there in a year.
Key terminology
- Tacker
- A device that delivers fixation tacks into tissue through a laparoscopic port or in open surgery. It is a delivery instrument, distinct from the tacks it delivers.
- Tack
- The fixation element itself — commonly a helical or spiral form that engages tissue as it is rotated in, or a clip-like element.
- Absorbable tack
- A tack made from an absorbable polymer, so the fixation element is resorbed after implantation. What remains and over what period is product-specific.
- Permanent tack
- A tack made from a material that is not resorbed, commonly a metal or a non-absorbable polymer.
- Suture fixation
- Holding the mesh with sutures placed by the surgeon rather than with a delivered device.
- Adhesive fixation
- Holding the mesh with a surgical adhesive rather than a mechanical element.
- Atraumatic fixation
- A term used for fixation approaches that do not pass a rigid element through the mesh and tissue. It describes the mechanism, not an outcome.
Technical characteristics
- Mechanical — device
- A tacker delivers tacks; the tacker is reusable or single-use depending on the product
- Mechanical — element
- Tacks, available in absorbable and permanent forms depending on the product
- Suture fixation
- Sutures placed by the surgeon; material chosen on its own properties
- Adhesive fixation
- A surgical adhesive rather than a mechanical element
- No fixation
- Some repairs use none. Whether fixation is required is a judgement about the repair.
- What remains
- Absorbable tacks are resorbed; permanent tacks and non-absorbable sutures remain. Periods are product-specific.
- Compatibility with the mesh
- Stated in the instructions for use for both the mesh and the fixation device.
- Indications
- Stated in the instructions for use. Approved indications vary by product and market.
How it compares
| Approach | Mechanism | Delivered by | What remains |
|---|---|---|---|
| Absorbable tack | Mechanical engagement | Tacker | Resorbed; period is product-specific |
| Permanent tack | Mechanical engagement | Tacker | The tack |
| Suture fixation | Mechanical, placed by hand | Needle and suture | Depends on the suture material |
| Adhesive | Adhesion rather than penetration | Applicator | Product-specific |
| No fixation | Not applicable | Not applicable | Nothing beyond the mesh |
What clinicians weigh when selecting
Fixation and mesh are separate choices
The mesh is selected on construction; the fixation on how it is to be held and by what. Treating them as one decision obscures both.
What is intended to remain
An absorbable tack is resorbed; a permanent one is not. The relevant question is what the surgeon intends to be present in the long term, answered against both products' instructions for use.
Penetrating against non-penetrating
Tacks and sutures pass an element through tissue; adhesives do not. That is a difference in mechanism, and what it means for a given repair is a clinical judgement.
Device and element are not the same product
A tacker is an instrument; the tacks are what it delivers. Specifications, and any reload or capacity limits, belong to the product documentation.
Compatibility
Whether a given fixation device is intended for use with a given mesh is stated in the instructions for use for both, and it is not assumed from the fact that both are surgical implants.
The instructions for use govern
Indications, contraindications, warnings and precautions for both the mesh and the fixation device are stated there and vary by market.
Frequently asked questions
What is a mesh tacker?
A device that delivers fixation tacks into tissue, used to hold a mesh in position. The tacker is the delivery instrument; the tacks are the fixation elements it places.
What is the difference between absorbable and permanent tacks?
An absorbable tack is made from a polymer that is resorbed after implantation, so the fixation element does not remain indefinitely. A permanent tack is made from a material that is not resorbed. The absorption period is product-specific and stated in the instructions for use.
Does mesh always need fixation?
No. Some repairs use no fixation at all. Whether fixation is used, and of what kind, is a clinical judgement about the repair rather than a property of the mesh.
Can any tacker be used with any mesh?
That is not an assumption to make. Whether a fixation device is intended for use with a given mesh is stated in the instructions for use for both products.
Is one fixation method better than another?
We do not rank fixation approaches. They differ in mechanism and in what remains in the body, and those differences are set out above so a clinician can reason about them.
How many tacks does a device deliver?
Capacity is product-specific and stated in the product documentation and instructions for use rather than here.
Instructions for use
The instructions for use supplied with the product is the controlled document for indications, contraindications, warnings, precautions, compatibility and any absorption specification — for the mesh and for the fixation device separately. Where this article and the instructions for use differ, the instructions for use govern. Approved indications vary by market.
Medical & regulatory notice
This article is general reference information for healthcare professionals about how surgical mesh is held in position. It is not medical advice, not surgical instruction, not a recommendation for any technique, procedure or patient, and not a substitute for the instructions for use supplied with the product or for clinical judgement. Product availability and approved indications vary by market. Dolphin Sutures manufactures surgical mesh and fixation devices; nothing here should be read as a claim of clinical benefit or of superiority over another product or approach.