Progressive fascial wound failure impairs subsequent abdominal wall repairs: a new animal model of incisional hernia formation.
BACKGROUND
Fascial wound failure alters the phenotype of the abdominal wall. This study introduces a novel animal model of progressive failure of the ventral abdominal wall fascia, which generates large incisional hernias.


METHODS
A mechanistic model of incisional hernia was compared with a model of acute myofascial defect hernia repair. Using biological tissue repair markers, tensiometric measurements and recurrent hernia rate, we measured the mechanism by which incisional hernias regenerate abdominal wall structure and function after mesh and suture herniorrhaphy.


RESULTS
Recurrent incisional hernia formation was significantly increased after repairs of the hernia model, compared with the myofascial defect model (6/16 vs 0/16, P < .05). In the hernia model, there were significant decreases in the recovery of wound strength, energy, and extensibility before mechanical disruption, compared with the myofascial defect model. Unexpectedly, excision of fascial hernia wound edges did not significantly improve tissue repair outcomes in the hernia model group.


CONCLUSIONS
Clinically accurate animal modeling can recreate the wound pathology expressed in mature incisional hernias. Progressive fascial wound failure decreases the fidelity of subsequent incisional hernia repair, compared with identically sized acute abdominal wall defect repairs. The mechanism appears to include decreased fascial wound strength and decreased tissue compliance after herniorrhaphy.
DuBay
Derek A
DA
Division of Gastrointestinal Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, 2292 H. Taubman Center, Ann Arbor, MI 48109-0331, USA.
Wang
Xue
X
Adamson
Belinda
B
Kuzon
William M
WM
Dennis
Robert G
RG
Franz
Michael G
MG
D000009:Abdominal Muscles / Q000601:surgery*; D000818:Animals; D024042:Collagen Type I / Q000235:genetics; D024061:Collagen Type III / Q000235:genetics; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000209:etiology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013314:Stress, Mechanical; D014945:Wound Healing
D024042:Collagen Type I; D024061:Collagen Type III