The reconstruction of abdominal wall defects is the problem with which surgeons are confronted more often. These defects may have an acute (trauma, cancer, infections) or chronic (hernia pathology) origin. Despite technical advances, the specific pathomechanisms and diverse treatment aspects remain controversial. In this line, surgeons and basic researchers work closely with other specialists (including pathologists, microbiologists, mathematicians and engineers) to better understand the promoting forces that trigger hernia formation and tissue rupture, from a mechanistic point of view. The studies are based on patient-derived tissue samples and primary fibroblasts, as well as on surgically-induced experimental models. Moreover, soft-tissue repair devices are being investigated by means of “in vitro” and “in vivo” experimental models. Quality care and surgical outcomes research studies are also developed.
1. Extracellular matrix, inflammation and cell death induction in abdominal wall defects. This line focuses on the role of cell-extracellular
matrix (ECM) interactions in the fields of inflammation and tissue repair. Recent data from our laboratory provide compelling evidence on how the local ECM may influence incisional hernia development. They suggest that fascia atrophy may be an active driver of the disease, by means of transducing signals that affect cell survival, functional phenotype, and (probably) gene expression. Also, they identify fibroblasts and cell fragility as major pathogenic contributors to incisional hernia formation. The accumulation of apoptotic-prone defective fascia fibroblasts may not support normal fascial structure and function, and thus enhance proteolytic fascial destruction in a context of low cell proliferation. Currently, we are investigating changes in subsets of genes from incisional hernia derived primary fibroblasts.
2. Biomaterials and soft tissue repair. Current surgical practice supports the use of permanent prosthetic meshes as the best method for hernia repair. Still, no material has gained a preference for universal use and numerous complications are still reported. This line analyzes different new generation materials for soft-tissue (self-)repair. Our approach includes the characterization of the devices surface and biomechanics, as well as the
analyses of host cell-substrate interactions, by means of “in-vitro” (primary fibroblasts derived from control and IH patients) and “in-vivo” (rats)
experimental models. The ultimate goal is to impact on the development of new tailored implants based on fibroblasts and biomimetic materials, which are clinically useful to mend damaged tissues.
3. To improve quality care and outcome procedures in the field of abdominal wall surgery, several aspects are evaluated from a clinical point of view: 1. Quality care procedures after elective and emergency hernia surgery, and patients’ follow-ups (outpatient visits, telephone, utili ty of a postal questionnaire); 2. Prevention and treatment of hernias (periostomal, incisional, and inguinal), and their related complications; Implementation of new technical procedures, such as the use of new-generation prosthetic materials and sutures, components’ separation technique (open/endoscopic); pre-peritoneal prosthetic mesh use in the treatment of inguinal hernia; hernia laparoscopic surgery; application of progressive pneumoperitoneum in the treatment of giant incisional hernias, etc.; 3. Biomaterials: validation of new architectures and designs (polymer scaffolds; extracellular matrix-derived biological implants; biodegradable and bioactive –ie, antibacterial properties- grafts); 4. Virtual Reality (in collaboration with the Universitat Rovira i Virgili, Tarragona, (URV), and the Universitat Politècnica de Catalunya (UPC)): Abdominal’s wall virtual simulation, for clinical and educational purposes; 5. Surgical Sutures (European Project).