Human Fascial Lata (HFL) is utilized in urogynecology and urology for incontinence procedures and, more recently, for sacrocolpopexy or graft-augmented vaginal repair when synthetic meshes aren't suitable (1,2). However, the durability of HFL grafts compared to synthetic mesh for sacrocolpopexy, known for its low recurrence rate, remains unclear. Moreover, understanding HFL's morphological, cellular, matrix, and immunological properties post-implantation is limited.
This research assesses HFL's morphometric features and in vivo response using a murine abdominal incision model. A direct comparison with synthetic polypropylene mesh is made to determine long-term implications and graft durability. The study also explores the molecular mechanisms driving HFL's integration for pelvic organ prolapse augmentation.
HFL tissue was collected from women undergoing sacrocolpopexy or pubovaginal sling insertion (n=26). Mice were implanted with HFL or synthetic mesh (n=8 mice/gp/time-point) via abdominal incision. Assessment occurred at 7 and 90-day intervals, involving histological stains, gene expression analysis, and immunofluorescence for macrophage response.
HFL is mainly collagenous connective tissue with few cells. Both grafts integrated well without erosions. At 7 days, HFL exhibited strong tissue integration with host cell infiltration, while polypropylene mesh displayed loose integration with inflammation and giant cell formation. Ongoing gene expression analysis suggests varied immune responses and integration mechanisms.
HFL outperforms polypropylene mesh in tissue integration and durability, making it a promising surgical graft for pelvic reconstruction. Advanced techniques offer insights into HFL's in vivo response, illuminating tissue integration and foreign body mechanisms. With its sturdy structural proteins, HFL emerges as an ideal implant for augmentative pelvic reconstructive procedures.