Abnormal Primary Tissue Collagen Composition in the Skin of Recurrent Incisional Hernia Patients

Abstract

Recurrence of incisional hernia may be as high as 50 per cent. Abnormal collagen I/III ratios have been observed within scar tissue of patients with recurrent incisional hernias. We sought to determine whether collagen composition in primary, nonscarred tissue was similarly affected in these patients. In this prospective, case–control study, nonscarred, primary abdominal wall skin and fascia biopsies were obtained in 12 patients with a history of recurrent incisional hernias and 11 control subjects without any history of hernia while undergoing abdominal laparoscopic surgery. Tissue protein expression of collagen I and III was assessed by immunohistochemistry followed by densitometry analysis. The collagen I/III ratio in skin biopsies from the recurrent hernia group was significantly less compared with control subjects (0.88 ± 0.01 versus 0.98 ± 0.04, respectively, P < 0.05). Fascia biopsies from patients with recurrent hernias was not significantly decreased in collagen I/III ratio compared with control subjects (0.90 ± 0.04 versus 0.94 ± 0.03, respectively, P = 0.17). Decreased collagen I/III ratios within the skin of patients with recurrent hernias not involved with scar or healing tissue suggest an underlying collagen composition defect. Such a primary collagen defect, in addition to abnormal scar formation, likely plays a significant role in the pathogenesis of recurrent incisional hernias.

Systematic review of trocar-site hernia

“…Closed laparoscopic entry19, 20, closure of the fascia16, 20, female sex20, 34, chronic bronchitis24, 39, diabetes39, 40, wound infection39, 40, previous hernia41, 42, previous abdominal surgery20, fascial manipulation20, 26 and quickly absorbable sutures23, 31, 36 are suggested risk factors for incisional hernia, but were not significant as risk factors in any of the included articles. The location of the trocar site is a controversial risk factor in the literature16, 26.…”

Pirfenidone reduces profibrotic responses in human dermal myofibroblasts, in vitro

“…Overall collagen I and III production is increased significantly in fibrotic disorders of the skin, such as scarring and keloid progression [17][18][19]. Although the quantity of collagen I is consistently greater than collagen III throughout the remodeling phase of wound healing, collagen III production initially increases relative to collagen I [17,18,20]. The ratio of collagen I/collagen III shifts over time with scar maturation.…”

“…The ratio of collagen I/collagen III shifts over time with scar maturation. Excessive collagen production and decreased collagen I/III ratio contributes to abnormal crosslinking and disorganized fiber bundle orientation associated with fibrotic scarring [17][18][19][20].…”

Activity of MMP‐9 after repair of abdominal wall defects with acellular and crosslinked bovine pericardium in rabbit

“…Collagen is the main substance of the extracellular matrix and constitutes the principal protein contributing to its tensile strength. Type I collagen represents the mature and most stable collagen form; type III collagen is an immature isoform, which is present at a greater concentration in the extracellular matrix of patients with incisional and inguinal hernias (4,5).…”