Study of differences in the biomechanical properties of samples of postoperative scars

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Introduction. It is known that any tissue of the human body is capable of displaying plastic properties, i.e. it can stretch or contract [7]. Under the influence of the force that acts on the tissue, the tissue is deformed. During surgery, the surgeon is faced with the question of which plastic surgery method to use in order to increase the effectiveness of postoperative recovery and reduce the risk of complications. This work is devoted to the study of the properties of the fibers of the matrix of a postoperative scar, which ultimately will give certain ideas about which method of plastic surgery contributes to the formation of scar tissue with high-quality mechanical properties. The purpose of the work. To identify differences in integrity indicators in the studied samples of postoperative scars in infected and clean wounds. Materials and methods of research. The biomechanical properties of scar tissue fragments from the anterior abdominal wall of 180 rats operated on for a herniated disc using various plastic surgery methods (local tissues, PPSS (polypropylene mesh), DBT (decellularized bioengineered graft)) The results of the study. In all operated animals, when they were removed (on the 30th and 180th days after surgery) from the experiment, a fragment of PBS was taken with mandatory capture of a site with DBT or PPP, or with a plastic area with local tissues in the form of rectangular flaps, 4-5 x 2-1.5 cm in size, containing a postoperative scar, which during During transportation to the laboratory of KSMU (Kursk), they were stored in a container with a cooled saline solution. Further study of the biomechanical properties of the postoperative anterior abdominal wall scar included an assessment of the absolute elongation of tissues with extensibility in the transverse and longitudinal directions on a bursting electromechanical machine in accordance with GOST 8847-85. During the tests, elongation at a standard load of 16 N and the load at which the samples ruptured were used as criteria. When analyzing the results, it was assumed that elongation at standard load characterized the elastic properties of the prosthetic aponeurosis, and the breaking load indicated its strength properties. From the values obtained in this way, the average elongation (elasticity) values were calculated, which were expressed as a percentage, and the average breaking load (strength) values were in N. To compare the experimental groups with the initial biomechanical properties of DBT and PPP before their implantation into the tissue, an intact polypropylene mesh with dimensions 4-5 x 1.5-2 and fragments of PBB with dimensions 9 ± 1.5 x 11 ± 1.5, obtained during autopsy of 2 male rabbits of the “White Giant" breed and decellularized with 2% SDS solution according to the developed protocol, and divided into rectangular flaps measuring 4-5 x 1.5-2 cm . The structure of the studied groups is presented in Table 1. Table 1. The structure of the groups operated on.

plastic surgery with local tissues	15	30	plastic surgery with local tissues	15	30	n=10	n=10
	15	180		15	180
plastic PPS	15	30	plastic PPS	15	30
	15	180		15	180
plastic DBT	15	30	plastic DBT	15	30
	15	180		15	180

 

The Kraskell-Wallis H-test was used to assess the significance of differences between groups, the median (Me) was used as a measure of the central trend, and the quartile interval (Q1-Q3) was used as a measure of variability. The results of the study of samples obtained from the groups of the 2nd stage of the study - plastic surgery of the anterior abdominal wall of laboratory animals under “clean wound” conditions, on the 30th (N=49.014, at p<0.001, N=53.063, at p<0.001) and 180th (N=55.009, at p<0.001, H=53.812, at p<0.001) day after surgery, it was shown that at standard load (16 N) in the longitudinal and transverse directions, the highest extensibility index was observed in the 4th control group (intact polypropylene mesh), while the lowest index was recorded in the 1st the experimental group (scar with local tissues). The most durable and elastic scars on the 30th and 180th days after surgery were those that formed after plastic surgery using a biograft and a mesh prosthesis. These data indicate that the use of DBT promotes the formation of scar tissue with high-quality mechanical properties, which may be a key factor in improving the effectiveness of postoperative recovery and reducing the risk of complications. When studying the biomechanical properties of scars formed in an infected wound, the following results were obtained: on the 30th day after plastic surgery, the most elastic scars in the longitudinal and transverse directions under standard load were in the group where a bioengineered graft was used. The longitudinal and transverse rupture study showed the highest results in the group where plastic surgery was performed using a decellularized bioengineered graft. In the group where a mesh prosthesis was used, on the 30th day after surgery, in 5 cases (33.5%), when a fragment of scar tissue was stretched, the PPS exfoliated from the soft tissues, which indicates an unsatisfactory process of mesh integration into the PBS tissues. Tensiometry of the scars on the 180th postoperative day showed that the maximum strength and elasticity was achieved during the repair of a hernial defect using a biotransplant. Conclusion. The data obtained indicate that the use of DBT promotes the formation of scar tissue with high-quality mechanical properties, which may be a key factor in improving the effectiveness of postoperative recovery and reducing the risk of complications.

About the authors

Аndrew Vladimirovich Kutsenko

Voronezh State Medical University named after N.N. Burdenko

Email: andreyla.kutsenko@yandex.ru
ORCID iD: 0009-0002-5203-0087
12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Julia Denisovna Rudneva

Voronezh State Medical University named after N.N. Burdenko

Email: julia.rudneva.03@mail.ru
ORCID iD: 0009-0000-4284-3012
Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Alexander Vasilyevich Chernykh

Voronezh State Medical University named after N.N. Burdenko

Email: chernyh@vrngmu.ru
ORCID iD: 0000-0002-6281-0020

D.М., Professor, Head of the Department of Operative Surgery with Topographic Anatomy

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Artyom Nikolaevich Shevtsov

Voronezh State Medical University named after N.N. Burdenko

Email: shan-87@yandex.ru
ORCID iD: 0000-0001-8641-2847

C.М., Associate Professor of the Department of Operative Surgery with Topographic Anatomy

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Asiyat Abdulnasirovna Magomedrasulova

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: ordinatura@vrngmu.ru
ORCID iD: 0000-0002-3158-1480

Assistant of the Department of Operative Surgery with Topographic Anatomy

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

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