Abstract
PurposeAlteration in fascial tissue collagen composition represents a key factor in hernia etiology and recurrence. Both resorbable and non-resorbable meshes for hernia repair are currently used in the surgical setting. However, no study has investigated so far the role of different implant materials on collagen deposition and tissue remodeling in human fascia. The aim of the present study was to develop a novel ex vivo model of human soft tissue repair mesh implant, and to test its suitability to investigate the effects of different materials on tissue remodeling and collagen composition.MethodsResorbable poly-4-hydroxybutyrate and non-resorbable polypropylene mesh implants were embedded in human abdominal fascia samples, mimicking common surgical procedures. Calcein-AM/Propidium Iodide vital staining was used to assess tissue vitality. Tissue morphology was evaluated using Mallory trichrome and hematoxylin and eosin staining. Collagen type I and III expression was determined through immunostaining semi-quantification by color deconvolution. All analyses were performed after 54 days of culture.ResultsThe established ex vivo model showed good viability at 54 days of culture, confirming both culture method feasibility and implants biocompatibility. Both mesh implants induced a disorganization of collagen fibers pattern. A statistically significantly higher collagen I/III ratio was detected in fascial tissue samples cultured with resorbable implants compared to either non-resorbable implants or meshes-free controls.ConclusionWe developed a novel ex vivo model and provided evidence that resorbable polyhydroxybutyrate meshes display better biomechanical properties suitable for proper restoration in surgical hernia repair.
Highlights
Reinforcement of the abdominal wall with mesh implants is the most widely applied and established procedure in abdominal hernia surgical repair procedures
We developed a pilot study aimed to assess the feasibility of a novel ex vivo model of abdominal hernia mesh implant, to determine the effects of two different mesh implant materials on collagen production and fascial tissue remodeling in vitro
In the present study we provide for the first time evidence of the suitability of a novel ex vivo tissue model of abdominal hernia mesh implant to determine the effects of two different mesh implant materials on collagen production and fascial tissue remodeling in vitro
Summary
Reinforcement of the abdominal wall with mesh implants is the most widely applied and established procedure in abdominal hernia surgical repair procedures. Both nonresorbable and fully resorbable soft tissue repair implants are currently available. All meshes inevitably cause a foreign body reaction which affects collagen deposition, and in particular the type I/type III collagen ratio. This further alters connective tissue strength due to a delayed induction in collagen I conversion from immature collagen III [1, 2]. Changes in this ratio affects biomechanical strength and stability in already injured fascial tissue and may increase the risk of hernia recurrence
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