Journal Mobile Options
Table of Contents
Vol. 32, No. 1, 2000
Issue release date: January–February 2000
Eur Surg Res 2000;32:43–48

Abnormal Collagen I to III Distribution in the Skin of Patients with Incisional Hernia

Klinge U. · Si Z.Y. · Zheng H. · Schumpelick V. · Bhardwaj R.S. · Klosterhalfen B.
Departments of aSurgery and bPathology, Technical University of Aachen, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


The surgical mesh-free repair of incisional hernias has to face recurrence rates of up to 50%. Apart from technical faults this is probably due to collagen metabolic disorders, known to play an important role in the development of inguinal hernia. In particular an altered ratio of collagen types I and III with an increase in collagen type III has been claimed to reduce the mechanical strength of connective tissues. Therefore, we investigated the content of collagen types I and III in the skin of patients with incisional hernia (n = 7) and recurrent incisional hernia (n = 5) in comparison to controls with healthy skin (n = 7) and normal skin scar (n = 7) both by immunohistochemistry and Western blot analysis. Both immunohistochemistry and Western blot analysis revealed a decrease in the ratio of collagen I/III due to a concomitant increase in collagen III. The patients with incisional hernias and with recurrent incisional hernias showed a ratio of 1.0 ± 0.1 and 0.8 ± 0.1, respectively, whereas the controls exhibit a ratio of 2.1 ± 0.2 in healthy skin and of 1.2 ± 0.2 in normal skin scar, respectively. The decrease was highly significant (p < 0.01) between the patients with either primary or recurrent hernia and the controls or the normal scar, as well as between controls and normal scar, whereas there was not any significant difference between primary and recurrent hernia (p > 0.05). Our data for the first time confirmed that the presence of incisional hernia is accompanied by impaired collagen synthesis in the skin. The decreased tensile strength of collagen type III may play a key role in the development of incisional hernias. Furthermore, it might explain the high recurrence rates of hernia repair by simple closure, as a repetition of the primarily failing technique, and the improvement by the additional use of alloplastic material.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Lowham AS, Filipi CL, Fitzgibbons RJ, Stoppa R, Wants G, Felix EL, Boyd, GF: Mechanisms of hernia recurrence after preperitoneal mesh repair. Ann Surg 1997;225:422–431.
  2. Einer L, Harder F: Narbenhernien. Chirurg 1997;68:304–309.
  3. Schumpelick V, Conze J, Klinge U: Die präperitoneale Netzplastik in der Reparation der Narbenhernien. Eine retrospektive Studie an 272 operierten Narbenhernien. Chirurg 1997;67:1028–1035.
  4. Korenkov M, Eypasch E, Paul A, Kohler L, Troid H: Auto-dermal hernioplasty – A rare and unknown technique. Zentralbl Chir 1997;122:871–878.
  5. Klinge U, Klosterhalfen B, Müller M, Schumpelick V: Foreign body reaction to meshes used for repair of abdominal wall hernias. Eur J Surg, in press.
  6. Klosterhalfen B, Klinge U, Schumpelick V: Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair. Biomaterials 1998;19:2235–2246.
  7. Klinge U, Prescher A, Klosterhalfen B, Schumpelick V: Entstehung und Pathophysiologie der Bauchwanddefekte. Chirurg 1997;68:293–303.
  8. Tsui S, Ellis H: Healing of abdominal incisional hernia in infant rats. Br J Surg 1991;72:739–740.
  9. Deak SB, Ricotta JJ, Mariani, TJ, Deak ST, Zatina MA, Mackenzie J, Boyd CD: Abnormalities in the biosynthesis of type III procollagen in cultured skin fibroblasts from two patients with multiple aneurysm. Matrix 1992;12:92–100.
  10. Rowe DW, Shapiro JR, Piorier M, Schlesinger S: Diminished type I collagen synthesis and reduced alpha 1(I) collagen messenger RNA in cultured fibroblasts from patients with dominantly inherited (type 1) osteogenesis imperfecta. J Clin Invest 1985;76:604–611.
  11. Leim MSL, Van der Graaf Y, Beemer FA, Van Vroonhoven TJMV: Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery 1997;122:114–115.
  12. Birk DE, Mayne R: Localization of collagen type I, III and V during tendon development. Changes in collagen types I and III are correlated with changes in fibril diameter. Eur J Cell Biol 1997;72:352–361.
  13. Dale PD, Sherratt JA, Maini PK: A mathematical model for collagen fibre formation during foetal and adult dermal wound healing. Proc R Soc Lond B 1996;263:653–660.
  14. Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, Deak SB: Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg 1993;218:754–760.
  15. Miller EJ, Rhodes RK: Preparation and characterisation of the different types of collagen. Methods Enzymol 1982;82:33–64.
  16. Pingoud A, Urbanke C: Arbeitsmethoden der Biochemie, ed 1. Berlin, Walter de Gruyter, 1996, pp 57–63.
  17. Laemmli UK: Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 1970;227:680–685.
  18. Sykes B, Puddle B, Francis M, Smith R: The estimation of two collagens from human dermis by interrupted gel electrophoresis. Biochem Biophys Res Commun 1976;72:1472–1480.
  19. Towbin H, Staehelin T, Gordon J: Electrophoretic transfer of proteins from polyacrylamide gels to nitrocellulose sheets: Procedures and some applications. Proc Natl Acad Sci USA 1979;76:4350–4354.
  20. Juhasz I, Murphy GF, Yan HC, Herlyn M, Albelda SM: Regulation of extracellular matrix proteins and integrin cell substratum adhesion receptors on epithelium during cutaneous human wound healing in vivo. Am J Pathol 1993;143:1458–1469.
  21. Krane SM, Byrne MH, Lemaitre V, Heriet Pjeffreg JJ, Witter JP, Liu X, Wu H, Jaenisch R, Eeckhont Y: Different collagenase gene products have different roles in degradation of type I collagen. J Biol Chem 1996;271:28509–28515.
  22. Arakawa M, Hatamochi A, Mori Y, Mori K, Ueki H, Moriguchi T: Reduced collagenase gene expression in fibroblasts from hypertrophic scar tissue. Br J Dermatol 1996;220:10–18.
  23. Friedman DW, Boyd CB, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, Deak SB: Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernia. Ann Surg 1993;218:754–760.
  24. Fleischmajer R, Perlish JS, Burgerson RE, Shaikh BF, Timpl R: Type I and type III collagen interactions during fibrillogenesis. Ann NY Acad Sci 1990;580:161–175.
  25. Uitto VJ, Perjda Aj, Abergel PR, Chu ML, Ramirez F: Altered steady-state ratio of type I/III procollagen mRNAs correlates with selectively increased type I procollagen biosynthesis in cultured keloid fibroblasts. Proc Natl Acad Sci USA 1985;82:5935–5939.
  26. Wagh PV, Read RC: Defective collagen synthesis in inguinal herniation. Am J Surg 1972;124:819–822.

    External Resources

  27. Ajabnoor MA, Mokhtar AM, Rafee AA, Taha AM: Defective collagen metabolism in Saudi patients with hernia. Ann Clin Biochem 1992;29:430–436.

    External Resources

  28. Krieg TH, Hein R, Hamamochi A, Aumaillay M: Molecular and clinical aspects of connective tissue. Eur J Clin Invest 1998;18:105–123.
  29. Tilstra DJ, Byers PH: Molecular basis of hereditary disorders of connective tissue. Annu Rev Med 1994;40:149–163.

    External Resources

  30. Fleischmajer R, Gay S, Perlish JS, Cesarini JP: Immunoelectron microscopy of type III collagen in normal and scleroderma skin. J Invest Dermatol 1980;75:189–191.
  31. Romanic AM, Adachi E, Kalder KE, Hojima Y, Prockop DJ: Copolymerization of pNcollagen III and collagen I. pNcollagen III decreases the rate of incorporation of collagen I into fibrils, the amount of collagen I incorporated, and the diameter of the fibrils formed. J Biol Chem 1991;266:12703–12709.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50