Incisional Hernia Development: Wound Healing Gone Wrong?

Incisional hernia (IH) is a common complication of abdominal surgeries, characterised by the protrusion of abdominal contents through a weakened surgical scar. Despite advancements in surgical techniques and biomaterials, IH remains a significant clinical and economic burden, with recurrence rates reaching up to 32% after repair. This unusually high number, despite many years of research focused on the improvement of surgical techniques, requires a better understanding of the potential origins of IH occurrence. This must implicate the tissues involved in scar formation of the abdominal wall for a better understanding of how these tissues are affected by the incision and what can potentially affect the most optimal wound healing. This work aimed to provide a comprehensive summary of the current knowledge regarding the ultrastructure of the abdominal wall and how incisions affect its mechanical integrity.