Multiscale Characterization of Mesh–Tissue Interface Disorganization in Chronic Mesh-Associated Inflammatory Remodeling Using Histology and Atomic Force Microscopy: An Exploratory Study

Background/Objectives: Chronic mesh-associated inflammatory remodeling may complicate abdominal wall repair through persistent foreign body response, fibrosis, and extracellular matrix disorganization. This exploratory study compared pathological and well-integrated mesh–tissue interfaces using histology and atomic force microscopy (AFM). Methods: Fourteen mesh–tissue complexes were analyzed: seven pathological explants and seven well-integrated reference specimens. Hematoxylin–eosin and Van Gieson staining assessed inflammation, foreign body reaction, fibrosis, and collagen organization. Contact-mode AFM evaluated surface topography, fibrillar-like organization, directionality, and ISO 25178-2 areal surface parameters. Values from 64 scans per specimen were averaged to obtain one specimen-level value, and groups were compared using the two-sided Mann–Whitney U test. Results: Pathological explants showed greater fibro-inflammatory heterogeneity, reduced collagen continuity, increased surface heterogeneity, discontinuous fibrillar-like features, and reduced structural organization. Sa, Sq, Sku, Sp, Sv, and Sz were higher, whereas Ssk was lower, in the pathological group (U = 0; exact two-sided p = 0.000583 for all parameters). Representative directional analysis suggested broader orientation distribution and reduced preferential alignment. Conclusions: Histology and AFM provided complementary morphological information on mesh–tissue remodeling. Larger standardized studies are required before AFM-derived parameters can be assigned diagnostic or prognostic significance.