Langenbeck's Archives of Surgery

, Volume 392, Issue 4, pp 465–471 | Cite as

Improved collagen type I/III ratio at the interface of gentamicin-supplemented polyvinylidenfluoride mesh materials

  • Karsten JungeEmail author
  • Uwe Klinge
  • Raphael Rosch
  • Petra Lynen
  • Marcel Binnebösel
  • Joachim Conze
  • Peter R. Mertens
  • Robert Schwab
  • Volker Schumpelick
Original Article



Formation of recurrent inguinal and incisional hernia shows an underlying defect in the wound-healing process with an insufficient quality of scar formation. Even after mesh repair an altered collagen formation and insufficient mesh integration has been found as main reason for recurrences. Therefore, the development of bioactive mesh materials to achieve a local modification of the scar formation to improve patients outcome is advisable.

Materials and methods

A polyvinylidenfluoride mesh material (PVDF) was constructed and surface modified by plasma-induced graft polymerization of acrylic acid (PVDF + PAAc). Surface supplementation was sought by binding of gentamicin to the provided active sites of the grafted mesh surfaces (PVDF+PAAc+Gentamicin). In vivo modulation of collagen formation was evaluated in a standardized animal model where an abdominal wall replacement was performed in 45 Sprague–Dawley rats. Seven, 21, and 90 days after mesh implantation, collagen/protein ratio and the collagen type I/III ratio as well as the expression of type I alpha 1 collagen mRNA (SYBR Green real-time RT-PCR) were analyzed at the perifilamentary region. Additionally, expression of matrix metalloproteinases (MMP-8/-13) has been investigated immunohistochemically.


Implantation of the PVDF + PAAc + Gentamicin mesh induced a significantly decreased expression of MMP-8 and MMP-13 at the interface 21 and 90 days after implantation compared to the other groups. Whereas no significant effect was observed comparing the overall collagen/protein ratio, the quality of collagen formation expressed by the collagen type I/III ratio showed significantly higher ratios around the PVDF + PAAc + Gentamicin mesh 21 and 90 days after implantation. Correspondingly, an up to 5.3-fold expression of type I alpha 1 collagen mRNA was found.


The present data confirm that a surface modification of PVDF mesh samples using plasma-induced graft polymerization of acrylic acid and supplementation of gentamicin is able to improve scar quality and mesh integration.


Mesh Collagen type I/III ratio Gentamicin Surface modification PVDF 



This work was supported by the German Federal Ministry of Education and Research (BMBF grant project no. 03N4024) and by the Deutsche Forschungsgemeinschaft (DFG Kl 1320/2-1).


  1. 1.
    Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135PubMedCrossRefGoogle Scholar
  2. 2.
    Jansen PL, Mertens PP, Klinge U, Schumpelick V (2004) The biology of hernia formation. Surgery 136(1):1–4PubMedCrossRefGoogle Scholar
  3. 3.
    Basson MD (2003) Invited research review: Cell–matrix interactions in the gut epithelium. Surgery 133(3):263–267PubMedCrossRefGoogle Scholar
  4. 4.
    Bellon JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G, Guerrero A et al (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive MMP-2 overexpression. Ann Surg 233(2):287–291PubMedCrossRefGoogle Scholar
  5. 5.
    Zheng H, Si Z, Kasperk R, Bhardwaj R, Schumpelick V, Klinge U et al (2002) Recurrent inguinal hernia: disease of the collagen matrix? World J Surg 26:401–408PubMedCrossRefGoogle Scholar
  6. 6.
    Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V (2002) A role for the collagen I/III and MMP−1/−13 genes in primary inguinal hernia? BMC Med Genet 3(1):2PubMedCrossRefGoogle Scholar
  7. 7.
    Rosch R, Junge K, Lynen P, Mertens PR, Klinge U, Schumpelick V (2003) Hernia—a collagen disease? Eur Surg 35:11–15CrossRefGoogle Scholar
  8. 8.
    Junge K, Klinge U, Klosterhalfen B, Rosch R, Stumpf M, Schumpelick V (2002) Review of wound healing with reference to an unrepairable abdominal hernia. Eur J Surg 168(2):67–73PubMedCrossRefGoogle Scholar
  9. 9.
    Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B et al (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 389(1):17–22PubMedCrossRefGoogle Scholar
  10. 10.
    Junge K, Rosch R, Klinge U, Krones C, Klosterhalfen B, Mertens PR et al (2005) Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis. Biomaterials 26(7):787–793PubMedCrossRefGoogle Scholar
  11. 11.
    Gupta B, Plummer C, Bisson I, Frey P, Hilborn J (2002) Plasma-induced graft polymerization of acrylic acid onto poly(ethylene terephthalate) films: characterization and human smooth muscle cell growth on grafted films. Biomaterials 23(3):863–871PubMedCrossRefGoogle Scholar
  12. 12.
    Lopez-De Leon A, Rojkind M (1985) A simple micromethod for collagen and total protein determination in formalin-fixed paraffin-embedded sections. J Histochem Cytochem 33(8):737–743PubMedGoogle Scholar
  13. 13.
    Junqueira LC, Cossermelli W, Brentani R (1978) Differential staining of collagens type I, II and III by Sirius Red and polarization microscopy. Arch Histol Jpn 41(3):267–274PubMedGoogle Scholar
  14. 14.
    Junge K, Klinge U, Klosterhalfen B, Mertens PR, Rosch R, Schachtrupp A et al (2002) Influence of mesh materials on collagen deposition in a rat model. J Invest Surg 15(6):319–328PubMedCrossRefGoogle Scholar
  15. 15.
    O’Meara SM, Cullum NA, Majid M, Sheldon TA (2001) Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 88(1):4–21PubMedCrossRefGoogle Scholar
  16. 16.
    Guo Y, Xie C, Rodriguez RM, Light RW (2005) Factors related to recurrence of spontaneous pneumothorax. Respirology 10(3):378–384PubMedCrossRefGoogle Scholar
  17. 17.
    Gilbert AI, Felton LL (1993) Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 177(2):126–130PubMedGoogle Scholar
  18. 18.
    Hanssen AD, Spangehl MJ (2004) Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res (427):79–85PubMedCrossRefGoogle Scholar
  19. 19.
    Tweed C (2005) Prevention of surgical wound infection: prophylactic antibiotics in colorectal surgery. J Wound Care 14(5):202–205PubMedGoogle Scholar
  20. 20.
    Deysine M (2004) Infections associated with surgical implants. N Engl J Med 351(2):193–195PubMedCrossRefGoogle Scholar
  21. 21.
    Tekos A, Prodromaki E, Papadimou E, Pavlidou D, Tsambaos D, Drainas D (2003) Aminoglycosides suppress tRNA processing in human epidermal keratinocytes in vitro. Skin Pharmacol Appl Skin Physiol 16(4):252–258PubMedCrossRefGoogle Scholar
  22. 22.
    Sacha PT, Zaremba ML, Jakoniuk P (1999) The influence of antibiotics on phagocytic and bacteriocidal activity of rabbit peritoneal macrophages stimulated by filtrates of cultured t-lymphocytes. Med Dosw Mikrobiol 51(3–4):399–412PubMedGoogle Scholar
  23. 23.
    Keeling KM, Bedwell DM (2002) Clinically relevant aminoglycosides can suppress disease-associated premature stop mutations in the IDUA and P53 cDNAs in a mammalian translation system. J Mol Med 80(6):367–376PubMedCrossRefGoogle Scholar
  24. 24.
    Wilschanski M, Yahav Y, Yaacov Y, Blau H, Bentur L, Rivlin J et al (2003) Gentamicin-induced correction of CFTR function in patients with cystic fibrosis and CFTR stop mutations. N Engl J Med 349(15):1433–1441PubMedCrossRefGoogle Scholar
  25. 25.
    Clancy JP, Bebok Z, Ruiz F, King C, Jones J, Walker L et al (2001) Evidence that systemic gentamicin suppresses premature stop mutations in patients with cystic fibrosis. Am J Respir Crit Care Med 163(7):1683–1692PubMedGoogle Scholar
  26. 26.
    Geleilete TJ, Melo GC, Costa RS, Volpini RA, Soares TJ, Coimbra TM (2002) Role of myofibroblasts, macrophages, transforming growth factor-beta endothelin, angiotensin-II, and fibronectin in the progression of tubulointerstitial nephritis induced by gentamicin. J Nephrol 15(6):633–642PubMedGoogle Scholar
  27. 27.
    Wrzesniok D, Buszman E, Karna E, Nawrat P, Palka J (2002) Melanin potentiates gentamicin-induced inhibition of collagen biosynthesis in human skin fibroblasts. Eur J Pharmacol 446(1–3):7–13PubMedCrossRefGoogle Scholar
  28. 28.
    Asch HL, Farnham PJ (1978) Effects of gentamicin on trypsin, chymotrypsin, and collagenase. J Infect Dis 138(2):257–259PubMedGoogle Scholar
  29. 29.
    Robson MC, Dubay DA, Wang X, Franz MG (2004) Effect of cytokine growth factors on the prevention of acute wound failure. Wound Repair Regen 12(1):38–43PubMedCrossRefGoogle Scholar
  30. 30.
    Dubay DA, Wang X, Kuhn MA, Robson MC, Franz MG (2004) The prevention of incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor. Ann Surg 240(1):179–186PubMedCrossRefGoogle Scholar
  31. 31.
    Korenkov M, Yuecel N, Koebke J, Schierholz J, Morsczeck C, Tasci I et al (2005) Local administration of TGF-beta1 to reinforce the anterior abdominal wall in a rat model of incisional hernia. Hernia 9(3):252–258Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Karsten Junge
    • 1
    • 4
    Email author
  • Uwe Klinge
    • 1
    • 3
    • 4
  • Raphael Rosch
    • 1
    • 4
  • Petra Lynen
    • 2
  • Marcel Binnebösel
    • 1
  • Joachim Conze
    • 1
  • Peter R. Mertens
    • 5
  • Robert Schwab
    • 1
  • Volker Schumpelick
    • 1
  1. 1.Department of SurgeryTechnical University of AachenAachenGermany
  2. 2.IZKF BIOMATTechnical University of AachenAachenGermany
  3. 3.Helmholtz-Institute of Biomedical Engineering, Applied Medical EngineeringTechnical University of AachenAachenGermany
  4. 4.German Centre of Excellence for Biomaterial and Implant PathologyTechnical University of AachenAachenGermany
  5. 5.Medical Clinic IITechnical University of AachenAachenGermany

Personalised recommendations