Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Franz MG (2006) The biology of hernias and the abdominal wall. Hernia 10(6):462–471

    Article  PubMed  Google Scholar 

  2. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571

    Article  PubMed  Google Scholar 

  3. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135

    Article  PubMed Central  PubMed  Google Scholar 

  4. Sorensen LT (2006) Effect of lifestyle, gender and age on collagen formation and degradation. Hernia 10:456–461

    Article  PubMed  Google Scholar 

  5. Henriksen NA, Yadete DH, Sorensen LT, Agren MS, Jorgesen LN (2011) Connective tissue alteration in abdominal wall hernia. Br J Surg 98:210–219

    Article  CAS  PubMed  Google Scholar 

  6. Liem MS, Van Der Graaf Y, Beemer FA, Van Vroonhoven TJ (1997) Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery 122:114–115

    Article  CAS  PubMed  Google Scholar 

  7. Girotto JA, Malaisrie SC, Bulkely G, Manson PN (2000) Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg 106:1520–1526

    Article  CAS  PubMed  Google Scholar 

  8. Lehnert B, Wadouh F (1992) High coincidence of inguinal hernias and abdominal aortic aneurysms. Ann Vasc Surg 6:578–582

    Google Scholar 

  9. Antoniou GA, Georgiadis GS, Antoniou SA, Granderath FA, Giannoukas AD, Lazarides MK (2011) Abdominal aortic aneurysm and abdominal wall hernia as manifestations of connective tissue disorder. J Vasc Surg 54(4):1175–1181

    Article  PubMed  Google Scholar 

  10. Klinge U, Zheng H, Si Z, Schumpelick V, Bhardwaj RS (1999) Expression of the extracellular matrix proteins collagen I, collagen III and fibronectin and matrix metalloproteinase-1 and -13 in the skin of patients with inguinal hernia. Eur Surg Res 31:480–490

    Article  CAS  PubMed  Google Scholar 

  11. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Investig Surg 14(1):47–54

    Article  CAS  Google Scholar 

  12. Binnebösel M, Klink CD, Otto J et al (2010) Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair. Hernia 14(1):71–77

    Article  PubMed  Google Scholar 

  13. Junqueira LC, Montes GS, Krisztan RM (1979) The collagen of the vertebrate peripheral nervous system. Cell Tissue Res 202:453–460

    Article  CAS  PubMed  Google Scholar 

  14. Maffulli N, Longo UG, Franceschi F (2008) Movin and Bonar scores assess the same characteristics of tendon histology. Clin Orthop Relat Res 466:1605–1611

    Article  PubMed Central  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  16. Casanova AB, Trindade EN, Trindade MR (2009) Collagen in the transversalis fascia of patients with indirect inguinal hernia: a case–control study. Am J Surg 198:1–5

    Article  PubMed  Google Scholar 

  17. Zhang R, Che X, Liu H, Fan L, Zhao W, Wang G (2007) Preliminary study on the content of Type I and Type III collagen in posterior rectus sheath in patients with inguinal hernia. J Xi’an Jiatong Univ 28:308–310

    Google Scholar 

  18. Rosch R, Junge K, Knops M, Lynen P, Klinge U, Schumpelick V (2003) Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg 387:427–432

    CAS  PubMed  Google Scholar 

  19. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32:43–48

    Article  CAS  PubMed  Google Scholar 

  20. White B, Osier C, Gletsu N et al (2007) Abnormal primary tissue collagen composition in the skin of recurrent incisional hernia patients. Am Surg 73:1254–1258

    PubMed  Google Scholar 

  21. Salameh JR, Talbott LM, May W, Gosheh B, Vig PJ, McDaniel DO (2007) Role of biomarkers in incisional hernias. Am Surg 73:561–567

    CAS  PubMed  Google Scholar 

  22. Szczesny W, Cerkaska K, Tretyn A, Dabrowiecki S (2006) Etiology of inguinal hernia: ultrastructure of rectus sheath revisited. Hernia 10:266–271

    Article  CAS  PubMed  Google Scholar 

  23. Junqueira L, Carneiro J (2004) Functionele histologie, 10th edn. Elsevier Gezondheidszorg, Maarssen, pp 133–134

    Google Scholar 

Download references

Acknowledgments

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.

Conflict of interest

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

Author information

Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    E. Peeters & M. Miserez

  2. Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    G. De Hertogh

  3. Department of Surgery, Technical University of Aachen, Pauwelsstraße, 52074, Aachen, Germany

    K. Junge & U. Klinge

Authors
  1. E. Peeters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. De Hertogh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Junge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Klinge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Miserez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Peeters.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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). https://doi.org/10.1007/s10029-013-1128-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-013-1128-1

Keywords

Search

Navigation