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Skin as marker for collagen type I/III ratio in abdominal wall fascia



An altered collagen metabolism could play an important role in hernia development. This study compared collagen type I/III ratio and organisation between hernia and control patients, and analysed the correlation in collagen type I/III ratio between skin and abdominal wall fascia.


Collagen organisation was analysed in Haematoxylin–Eosin sections of anterior rectus sheath fascia, and collagen type I/III ratio, by crosspolarisation microscopy, in Sirius-Red sections of skin and anterior rectus sheath fascia, of 19 control, 10 primary inguinal, 10 recurrent inguinal, 13 primary incisional and 8 recurrent incisional hernia patients.


Compared to control patients [7.2 (IQR = 6.8–7.7) and 7.2 (IQR = 5.8–7.9)], collagen type I/III ratio was significantly lower in skin and anterior rectus sheath fascia of primary inguinal [5.2 (IQR = 3.8–6.3) and 4.2 (IQR = 3.8–4.7)], recurrent inguinal [3.2 (IQR = 3.1–3.6) and 3.3 (IQR = 3–3.7)], primary incisional [3.5 (IQR = 3–3.9) and 3.4 (IQR = 3.3–3.6)] and recurrent incisional hernia [3.2 (IQR = 3.1–3.9) and 3.2 (IQR = 2.9–3.2)] patients; also incisional and recurrent inguinal hernia had lower ratio than primary inguinal hernia patients. Furthermore, collagen type I/III ratio was significantly correlated (r = 0.81; P < 0.001) between skin and anterior rectus sheath fascia. Finally, collagen organisation was comparable between hernia and control patients.


Furthermore, in both skin and abdominal wall fascia of hernia patients, collagen type I/III ratio was lower compared to control patients, with more pronounced abnormalities in incisional and recurrent inguinal hernia patients. Importantly, collagen type I/III ratio in skin was representative for that in abdominal wall fascia.

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EP is supported by a Ph.D. grant of the Institute for the Promotion of Innovation through Science and Technology in Flanders (IWT Vlaanderen). MM is supported by a research grant from the Fund for Scientific Research Flanders (FWO-Vlaanderen). The authors gratefully thank Steffen Fieuws from the Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat) for his help with the statistical analyses and Ellen Krott for her help with the Sirius Red analyses.

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None of the authors have any conflicts of interest to declare concerning this manuscript.

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Correspondence to E. Peeters.

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Peeters, E., De Hertogh, G., Junge, K. et al. Skin as marker for collagen type I/III ratio in abdominal wall fascia. Hernia 18, 519–525 (2014).

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  • Abdominal wall hernia
  • Etiology
  • Collagen type I/III
  • Collagen organisation
  • Skin
  • Anterior rectus sheath fascia