Characterising the extracellular matrix composition of human fascia lata across age as an autologous graft for pelvic organ prolapse repair. — ASN Events
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Characterising the extracellular matrix composition of human fascia lata across age as an autologous graft for pelvic organ prolapse repair. (#524)

Lily M Anthony 1 2 , Hamid R Bidkhori 1 2 , Jennifer M Hackett 1 2 , Anna Rosamilia 1 2 3 4 , Shayanti Mukherjee 1 2
  1. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
  2. Hudson Institute of Medical Research, Clayton, VICTORIA, Australia
  3. Cabrini Health, Malvern, VIC, Australia
  4. Pelvic Floor Disorders Unit, Monash Health, Clayton, VIC, Australia

Background: Pelvic Organ Prolapse (POP) occurs when the female pelvic organs descend outside the pelvic cavity, with a 50% prevalence in parous women, often developing post-menopause. POP was previously treated with polypropylene mesh, but was banned due to adverse complications. Urogynaecologists currently utilise alternative treatments for sacrocolpopexy, such as human fascia lata (HFL), a multilayered, dense fibrous connective tissue sheath of the outer thigh. It is unknown whether the composition of HFL alters with age, so clinicians are concerned it could impact patient outcomes in certain age groups. Therefore, we aimed to characterise the composition of the HFL across age to establish evidence-based guidelines for confident clinical applications of HFL grafts for POP treatment.

Methods: HFL was harvested via lateral thigh incision with a 3cm transverse cut during sacrocolpopexy, with a small sample retained after obtaining ethical approval. Samples were stratified by age (group A (<54 years) (n=7), group B (55-69 years) (n=9), and group C (>70 years) (n=9) to reflect postmenopausal hormonal changes. Histological and immunofluorescent staining was conducted on HFL in formalin-fixed, paraffin-embedded sections, quantified using HALO Image Analysis or QuPath 0.6.0 and compared using a Kruskal-Wallis test with a Dunn’s post-hoc correction for multiple comparisons.

Results: No significant age-related differences in composition were found across age groups for extracellular matrix (ECM) markers Collagen I (p=0.15), Collagen III (p=0.10), Elastin (p=0.32) and Decorin (p=0.88). There was extensive expression of Collagen V in fibrous tissue and Collagen IV in the basement membrane. We also identified co-localisation of endothelial adhesion marker CD31 and vascular/myofibroblast marker ⍺-SMA.

Conclusion: These findings suggest that HFL maintains structural and compositional ECM integrity across ages, supporting its continued use as an autologous graft for women irrespective of age. Therefore, providing an evidence-based foundation for clinicians to offer HFL as a patient-tailored option for POP repair.