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.