Incisional hernia recurrence through genomic profiling: a pilot study.

PURPOSE: Although situational risk factors for incisional hernia formation are known, the methods used to determine who would be most susceptible to develop one are unreliable. We hypothesized that patients with recurrent incisional hernias may possess unique gene expression profiles. METHODS: Skin and intact fascia were collected from 15 normal control (NC) patients with no hernia history and 18 patients presenting for recurrent incisional hernia (RH) repair. Microarray analysis was performed using whole genome microarray chips on NC (n = 8) and RH (n = 9). These samples were further investigated using a pathway-specific PCR array containing fibrosis-related genes. RESULTS: Microarray data revealed distinct differences in the gene expression profiles between RH and NC patients. One hundred and sixty-seven genes in the skin and 7 genes in the fascia were differentially expressed, including 8 directly involved in collagen synthesis. In particular, GREMLIN1, or bone morphogenetic protein antagonist 1, was under expressed in skin (fold = 0.49, p < 10(-7), q = 0.0009) and fascia (fold = 0.23, p < 10(-4), q = 0.095) of RH patients compared with NC. The PCR array data supported previous reports of decreased collagen I/III ratios in skin of RH versus NC (mean = 1.51 ± 0.73 vs. mean = 2.26 ± 0.99; one-sided t test, p = 0.058). CONCLUSION: To our knowledge, this is the first microarray-based analysis to show distinct gene expression profiles between the skin and fascia of RH and NC patients and the first report of an association between GREMLIN1 and incisional hernia formation. Our results suggest that gene expression profiles may act as surrogate markers that stratify patients into different groups at risk for hernia development prior to their initial surgery.

Technical validation of the Di3D stereophotogrammetry surface imaging system.

The purpose of this work was to assess the technical performance of a three-dimensional surface imaging system for geometric accuracy and maximum field of view. The system was designed for stereophotogrammetry capture of digital images from three-dimensional surfaces of the head, face, and neck. A mannequin head was prepared for imaging by adding texture in the form of red paint, and facial landmarks as black ink dots. The mannequin was imaged at the manufacturer's recommended settings for human studies. Colour-coded surface difference images among repeated exposures were computed. We compared measurements of physical linear distance with digital measurements. The three-dimensional stereophotogrammetry system had a mean error in the three-dimensional surfaces of 0.057mm, a repeatability error (variance) of 0.0016mm, a mean error of 0.6mm in linear measurements compared with manual measurements, and a field of view of 170 degrees horizontally and 102 degrees vertically.