Double‐Layer Asymmetric Porous Mesh with Dynamic Mechanical Support Properties Enables Efficient Single‐Stage Repair of Contaminated Abdominal Wall Defect

Abstract Contamination tolerance and long‐term mechanical support are the two critical properties of meshes for contaminated abdominal wall defect repair. However, biological meshes with excellent pollution tolerance fail to provide bio‐adaptive long‐term mechanical support due to their rapid degradation. Here, a novel double‐layer asymmetric porous mesh (SIS/PVA‐EXO) is designed by simple and efficient in situ freeze–thaw of sticky polyvinyl alcohol (PVA) solution on the loosely porous surface of small intestinal submucosal decellularized matrix (SIS), which can successfully repair the contaminated abdominal wall defect with bio‐adaptive dynamic mechanical support through only single‐stage surgery. The exosome‐loaded degradable loosely porous SIS layer accelerates the tissue healing; meanwhile, the exosome‐loaded densely porous PVA layer can maintain long‐term mechanical support without any abdominal adhesion. In addition, the tensile strength and strain at break of SIS/PVA‐EXO mesh change gradually from 0.37 MPa and 210% to 0.10 MPa and 385% with the degradation of SIS layer. This unique performance can dynamically adapt to the variable mechanical demands during different periods of contaminated abdominal wall reconstruction. As a result, this SIS/PVA‐EXO mesh shows an attractive prospect in the treatment of contaminated abdominal wall defect without recurrence by integrating local immune regulation, tissue remodeling, and dynamic mechanical supporting.