title: Skin as marker for collagen type I/III ratio in abdominal wall fascia.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium, ellen.peeters@med.kuleuven.be.
authors.forename: E
authors.initials: E
authors.lastname: Peeters
authors.forename: G
authors.initials: G
authors.lastname: De Hertogh
authors.forename: K
authors.initials: K
authors.lastname: Junge
authors.forename: U
authors.initials: U
authors.lastname: Klinge
authors.forename: M
authors.initials: M
authors.lastname: Miserez
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology*; D000328:Adult; D024042:Collagen Type I / Q000378:metabolism*; D024061:Collagen Type III / Q000378:metabolism*; D005205:Fascia / Q000378:metabolism; D005260:Female; D046449:Hernia, Abdominal / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012867:Skin / Q000378:metabolism*; D055815:Young Adult
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III