Abstract
Background. Recent findings of an impaired protein ratio of type I to type III procollagen showed
a disturbed collagen metabolism in incisional hernia development. We analyzed the
type I and type III procollagen messenger RNA to investigate whether these findings
represent the altered extracellular matrix or a primary defect at the transcriptional
level. Methods. We examined cultured skin fibroblasts of patients with incisional or recurrent incisional
hernia in comparison with those without any previous incision (control) and those
with a skin scar without clinical appearance of a hernia (scar). Immunohistochemical
detection of a lowered protein ratio of type I and type III collagen in the hernia
skin tissue leads to mRNA expression analysis. The procollagen mRNA and the ratio
of type I to type III procollagen mRNA are detected by reverse transcriptase-polymerase
chain reaction and Northern blot analysis, the collagens type I and III by Western
blot analysis. Results. Reverse transcriptase-polymerase chain reaction revealed an increase of type I procollagen
mRNA in the incisional and recurrent hernia (0.90 ± 0.04 and 1.19 ± 0.04, respectively)
compared with stable scar (0.54 ± 0.02) or healthy tissue (0.43 ± 0.01). The obvious
rise of type III procollagen mRNA to 4.13 ± 0.04 for incisional, 6.02 ± 0.03 for recurrent
hernia, 2.29 ± 0.04 for stable scar, and 1.72 ± 0.03 for the healthy tissue showed
a significantly decreased ratio of type I to type III procollagen mRNA in the hernia
patients as compared with the controls (P <.01). By Western blot analysis, an increase of type I and type III collagen protein
and a significant rise in the corresponding ratio in the recurrent hernia group were
detected. Conclusions. The altered synthesis of type I and type III collagen in cultured skin fibroblasts
suggests a disorder of collagen metabolism, at least in patients with recurrent hernia.
Hence, a basically impaired wound healing process is likely to contribute to the unsatisfactory
results of incisional hernia repair. (Surgery 2002;131:324-31.)
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Article info
Publication history
Accepted:
November 1,
2001
Footnotes
*Supported by the Federal Ministry of Education and Research (Germany) grant project 01KS9503/9 for the Interdisciplinary Center for Medical Research on Biomaterials and Implant Tissue-Interfaces, The Aachen University of Technology, the German Research Foundation (Kl 1320/2-1), and ETHICON, Norderstedt, Germany.
**Reprint requests: Uwe Klinge, MD, Department of Surgery, The Technical University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
