Abdominal Dermis Tensile Strength in Aesthetic and Massive Weight-Loss Patients and Its Role in Ventral Hernia Repair: A Cross-Sectional Study

BACKGROUND: Skin tissue characteristics have been researched for years, particularly with regard to tissue engineering.¹ Clarifying the biomechanics of abdominal skin could lead to different uses for this tissue, for example, the ventral repair of hernias where prostheses are contraindicated.² The objectives of this study were to compare the maximum tensile strength of abdominal skin to commercial meshes, and to verify whether it varies between aesthetic patients and massive weight-loss patients.

METHODS: This is a descriptive cross-sectional study. Skin samples with dimensions of 32x20 mm were taken from 15 abdominoplasties and 10 panniculectomies. The skin flaps were analyzed in vertical and horizontal tensile tests with a device designed for the study. The results were compared among the two groups and the traction directions. Commercial meshes available in Brazil were also tested. The results were analyzed using the Mann–Whitney U test and the Wilcoxon signed-rank test.

RESULTS: The aesthetic and post-bariatric groups were similar in most baseline characteristics, except age which was 37.2 ± 9.9 years in abdominoplasty patients and 45.9 ± 8.8 in panniculectomy patients (p = 0.481). The maximum tensile strength supported vertically by abdominal dermis was 403.5 N (95% CI; 342.4–464.5 N) in the abdominoplasty group and 425.9 N (95% CI; 345.0–506.9 N) in the panniculectomy group, with no significant difference between them. Horizontally, the values were 596.5 N (95% CI; 524.9–668.1 N) and 612.5 N (507.6–717.4 N), also with no significant difference. In both groups, the skin was more resistant horizontally than vertically  (p < 0.001). Tested commercial meshes had the following values: polypropylene 104.6 N, low-weight polypropylene 54.4 N, polytetrafluorethylene (PTFE) 82.2 N, and hydrated porcine small-intestinal submucosa 60.0 N.

DISCUSSION: Previous studies were consistent with our results for the vertical and horizontal dermal forces, but with a smaller number of samples from aesthetic patients.³ In our study, the biomechanical properties of human abdominal dermis presented an alternative to the meshes used in the repair of hernia defects. In selected cases, it could be a tool in abdominal reconstruction during panniculectomies with concomitant hernia repair.⁴