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Background
The purpose of this study was to determine whether imbrication of native fascia versus
excision and closure of new raw fascia forms a stronger union.
Methods
We utilized the anterior rectus sheath fascia of Sprague-Dawley rats as the model.
Sixty rats underwent fascial tightening procedures. Each rat had the anterior rectus
sheath shortened by 1 cm, 30 by imbrication and 30 by excision and closure. Ten of
each group were harvested at 7 days' healing, 10 at 14 days, and 10 of each group
at 28 days' healing. The anterior rectus sheath was removed, a “dumbbell” shape constructed,
and the cross sectional area at the point of interest determined. The fascia was placed
on an Instron tensiometer to determine the breaking strength. Tensile strength was
calculated and the data analyzed by ANOVA and the Kruskall-Wallis test. Tissue samples
of the closures were histologically analyzed for fibroblast counts, degree of inflammation,
and presence of dense fibrous connective tissue. Tissue samples were also analyzed
for enzymatic collagen crosslinking.
Results
There was a statistically significant difference in tensile strength between the two
groups at 7, 14, and 28 days. Results show that at 7 days the mean tensile strength
of excision was 0.133 kg/mm2 ± 0.056 and the mean tensile strength of imbrication was 0.083 kg/mm2 ± .048 (P <0.05); at 14 days the mean tensile strength of excision was 0.105 kg/mm2 ± 0.033 and the mean tensile strength of imbrication was 0.057 kg/mm2 ± 0.014 (P <0.002), and at 28 days the mean tensile strength of excision was 0.279 kg/mm2 ±0.143 and the mean tensile strength of imbrication was 0.145 kg/mm2 ± 0.061 (P <0.03). Histologic findings showed no statistical significance between the two closure
methods when comparing degree of inflammation or the number of fibroblasts present.
However, at 7 and 14 days there is a significantly greater presence of dense fibrous
connective tissue in the excision group (P < 0.03 at 7 days and P < 0.044 at 14 days by ANOVA). Collagen crosslink analysis showed that by day 28 there
is a significantly greater amount (P <0.05 by ANOVA) of the difunctiorial crosslink dihydroxylysinonorleucine (DHLNL)
and a greater ratio between DHLNL and the difunctional crosslink hydroxylysinonorleucine
(HLNL) in the excision and closure group.
Conclusion
We conclude that at 7,14, and 28 days healing, excision provides a significantly stronger
closure than imbrication. According to the crosslinking analysis, it is likely that
this strength advantage may continue to increase over time. These findings suggest
that excision and closure may be the preferred method for fascial tightening procedures.
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Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
***The viewpoints expressed in this paper are solely those of the authors and do not represent those of the United States Air Force or the Department of Defense.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
