Abdominal skin tensile strength in aesthetic and massive weight loss patients and its role in ventral hernia repair

Abstract

Background Clarifying the biomechanics of abdominal skin could lead to different uses for this tissue such as the ventral repair of hernias in patients with excess skin and incisional hernias. The objective of this study was to compare the maximum tensile strength of abdominal skin to commercial meshes and to verify whether or not it varies between aesthetic patients and massive weight-loss patients. Methods Experimental cross-sectional study. Skin samples sized 32 × 20 mm were taken from 15 abdominoplasties and 10 panniculectomies. The skin specimens were analyzed in vertical and horizontal tensile strength tests. Results were compared between the two groups including their traction directions. Commercial meshes were also tested. The results were analyzed using the Generalized Estimating Equation. Results The maximum tensile strength supported vertically by abdominal dermis was 403.5 ± 27.4 N in the abdominoplasty group and 425.9 ± 33.9 N in the panniculectomy group. Horizontally, the values were 596.5 ± 32.2 N and 612.5 ± 43.9 N respectively. The strengths between traction directions were significantly different ( p < 0.001). There were no differences between the groups with regard to the maximum tensile strength ( p = 0.472). Tested commercial meshes had the following values: polypropylene 104.6 N, low-weight polypropylene 54.4 N, polytetrafluorethylene (PTFE) 82.2 N, and hydrated porcine small-intestinal submucosa 60.0 N. Conclusion In our study, the tensile strength of the tested human abdominal dermis samples, both aesthetic and post-bariatric, was superior to the commercial meshes. Therefore, in selected cases, abdominal dermis could be an alternative tool in abdominal reconstruction during panniculectomies with concomitant hernia repair. Electronic supplementary material The online version of this article (10.1186/s12893-019-0523-7) contains supplementary material, which is available to authorized users.

Reply: Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty

“…Pannucci et al 4 previously reported a 6.8 percent risk of clinically relevant bleeding in patients who received enoxaparin 40 mg twice daily. Importantly,…”

“…If sufficient quality dermis is available as a donor tissue, however, it is certainly a potentially low-cost option. Abdominal dermis has similar or higher tensile strength compared to even some synthetic meshes, 4 but it can be prone to stretch and expansion when tension is applied, which can lead to bulging or hernia recurrence.…”

Anatomical Basis of Biomechanical Properties of Superficial Tissues of the Anterior Abdominal Wall

“…Biomechanical studies performed on full-skin and dermal collagen separately give almost identical results. The mechanical properties of the dermis, in turn, depend on the structure, density and direction of collagen fibres [6,22,23].…”

“…Each biological tissue is able to acquire deformation properties to stretch or contract. At each stage of deformation changes in histoarchitectonics (reversible -within the plastic characteristics, irreversible -outside these parameters) are revealed in the tissues of different topographic and anatomical areas, which to some extent affect the physiological and functional mechanisms of the tissue [22,24].…”