The global withdrawal of transvaginal polypropylene mesh due to safety concerns has prompted the need for effective, biocompatible alternatives in pelvic reconstructive surgery. Human fascia lata (HFL), an autologous graft, has been used in anti-incontinence procedures and is increasingly explored for prolapse repair. This pre-clinical study compares HFL to polypropylene mesh, evaluating mechanical properties, host immune response, and extracellular matrix (ECM) remodelling.

Fascial grafts were harvested from 26 female patients undergoing autologous fascial sling or sacrocolpopexy with ethical approval (protocol #01-01-09-22). Mechanical strength was measured via cyclic uniaxial loading (100% stretch, three cycles) followed by failure testing. An in vivo abdominal implantation model in C57BL/6 mice (n=8 per group per time point) assessed host response at 7 and 90 days (Figure 1). Explants underwent histology (H&E, Masson’s trichrome, elastin), scanning electron microscopy (SEM), and polarized imaging for collagen organization. Gene expression and immune profiling were performed via qPCR and single-cell proteomics. Statistical analysis was conducted using the Mann-Whitney U test.

By day 7, HFL grafts showed rapid neovascularization and cellular infiltration, while polypropylene mesh triggered acute neutrophilic inflammation and foreign body giant cells. HFL retained 50% of its tensile strength post-cyclic loading versus 13% in polypropylene (p<0.01). Polarized imaging revealed loosely organized collagen III in HFL explants, indicative of active remodelling, while polypropylene showed dense, aligned fibers. SEM confirmed preserved fibrous architecture in HFL at 90 days with no erosions. qPCR revealed increased expression of neovascular and ECM markers (CD90, CD31, CD38, Tgfb1, Tgfbr1, Timp2, Mmp3, Mmp9) and a balanced M1/M2 macrophage response, supporting favorable tissue integration (Figure 2).

HFL exhibits superior biomechanical resilience and host integration compared to polypropylene mesh. Its collagen-rich matrix promotes tissue remodelling and reduces adverse immune responses, making it a promising autologous alternative for pelvic organ prolapse and incontinence surgery. Further clinical validation is warranted.