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Collagen Analysis in Incisional Hernias

BACKGROUND Incisional hernia is defined as an abnormal protrusion of a viscus through the musculo-aponecrotic layer of a surgical scar and occurs in 5 – 15 % of laparotomy closures. Mostly they are iatrogenic. Postoperative infection is the most common cause. Collagen is responsible for most of the strength of the wound. There are 13 types of collagen with 25 different polypeptide chains. The fiber forming collagen are type 1,2,3,5 and 11. Synthesis of collagen is complex. METHODS 63 patients undergoing repair for Incisional hernias were studied for their by demographic details such as age, gender, social status and nutritional status after taking informed consent. A small bit of non-scarred skin was taken located away from the site of previous surgery and scar tissue. A small piece of transversalis fascia also taken under direct vision away from any scar, hernia defects, or other pathology. The two bits were fixed in 20 % formaldehyde. They were sectioned and examined after staining with Hematoxylene and eosin stain for abnormal collagen patterns and discontinuity in collagen bundles. RESULTS Total cases studies – 50. 26 (52 %) patients were in the age group of 30 to 40 years, followed by 12 (24 %) in the age group of 40 to 50 years. 09 (18 %) were in the age group of 20 to 30 years. The risk factors noted in the 50 subjects in the study were tabulated in Table 6 showed 20 (40 %) had lax abdominal wall, 12 (24 %) had Diabetes Mellitus, 09 (18 %) had Anaemia, 05 (10 % had malignancy and 04 (08 %) had jaundice. Among the 50 patients 31 (62 %) were found to have abnormal collagen tissues and 19 (38 %) had normal collagen tissues. CONCLUSIONS Defective collagen tissue formation was the cause for Incisional hernia especially in the elderly female patients. Emergency surgeries, lower abdominal incisions were more prone to Incisional hernias. Wound infection, malnutrition, Anemia, associated malignancy, pulmonary infections and co-morbidity played an important role in its causation. KEY WORDS Wound Healing, Collagen, Incision and Hernia