Abstract
Two fundamental biological differences between normal fascia and scar tissue are rate of collagen turnover and physical weave of collagen subunits. Both factors account for unsatisfactory results following ventral hernia repair unless scar tissue is excised and normal fiscia used. Removal of scar and identification of normal fascia often require extensive dissection, entrance into the peritoneal cavity, and sometimes requires lysis of intestinal adhesions with occasional injury to bowel. Simple imbrication of the hernia sac, as in treatment of a direct inguinal hernia, without excision usually results in recurrence of the hernia because of remodeling and attenuation of scar tissue. A new procedure, based upon the technique of direct inguinal hernia repair without opening peritoneum, has been performed on 12 patients with large ventral hernias. The procedures, performed entirely in a subcutaneous plane, involves imbrication of scar, transfer of a massive fascial onlay graft, and use of an internal stent. Patients have been followed for one to 5 years; there have been no recurrences. Inductive influence of the fascial transplant has been measured in two patients; a tenfold increase in net collagen synthesis and deposition occurs for at least one year following transplantation of fascia to an imbricated scar recipient area.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arem A. J., Madden J. W. Is there a Wolff's law for connective tissue? Surg Forum. 1974;25(0):512–514. [PubMed] [Google Scholar]
- Boerema I. Cause and repair of large incisional hernias. Surgery. 1971 Jan;69(1):111–116. [PubMed] [Google Scholar]
- Dubiel W. T., Wigren A. Functional status of the lower extremity after resection of fascia lata. A clinical and physiological follow-up study in patients with fascia lata heart valve replacement. Acta Orthop Scand. 1974;45(4):599–613. doi: 10.3109/17453677408989183. [DOI] [PubMed] [Google Scholar]
- Gallie W. E., Lemesurier A. B. The Use of Living Sutures in Operative Surgery. Can Med Assoc J. 1921 Jul;11(7):504–513. [PMC free article] [PubMed] [Google Scholar]
- Madden J. W., Peacock E. E., Jr Studies on the biology of collagen during wound healing. 3. Dynamic metabolism of scar collagen and remodeling of dermal wounds. Ann Surg. 1971 Sep;174(3):511–520. doi: 10.1097/00000658-197109000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Merritt W., Peacock E. E., Jr, Chvapil M. Comparative biology of fascial autografts and allografts. Surg Forum. 1974;25(0):524–526. [PubMed] [Google Scholar]
- Peacock E. E., Jr, Madden J. W. Studies on the biology and treatment of recurrent inguinal hernia. II. Morphological changes. Ann Surg. 1974 May;179(5):567–571. doi: 10.1097/00000658-197405000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Peterkofsky B., Diegelmann R. Use of a mixture of proteinase-free collagenases for the specific assay of radioactive collagen in the presence of other proteins. Biochemistry. 1971 Mar 16;10(6):988–994. doi: 10.1021/bi00782a009. [DOI] [PubMed] [Google Scholar]
- TRACE H. D., KOZOLL D. D., MEYER K. A. Factors in the etiology and management of postoperative ventral hernias. Am J Surg. 1950 Nov;80(5):531–539. doi: 10.1016/0002-9610(50)90419-3. [DOI] [PubMed] [Google Scholar]
- USHER F. C. Hernia repair with Marlex mesh. An analysis of 541 cases. Arch Surg. 1962 Mar;84:325–328. doi: 10.1001/archsurg.1962.01300210059012. [DOI] [PubMed] [Google Scholar]
- WIRTSCHAFTER Z. T., BENTLEY J. P. HERNIAS AS A COLLAGEN MATURATION DEFECT. Ann Surg. 1964 Nov;160:852–859. doi: 10.1097/00000658-196411000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WOESSNER J. F., Jr The determination of hydroxyproline in tissue and protein samples containing small proportions of this imino acid. Arch Biochem Biophys. 1961 May;93:440–447. doi: 10.1016/0003-9861(61)90291-0. [DOI] [PubMed] [Google Scholar]