Extracellular Matrix Disorganization at the Mesh–Tissue Interface in Chronic Surgical Mesh Rejection: A Multiscale Morphological Study

Chronic surgical mesh rejection is a complex pathological process characterized by persistent inflammation, foreign body reaction, and progressive extracellular matrix (ECM) remodeling, leading to impaired tissue integration. Although histopathological features are well described, the structural organization of the ECM at the mesh–tissue interface remains insufficiently understood. This study aimed to investigate multiscale morphological alterations associated with chronic mesh rejection, with emphasis on ECM disorganization and loss of structural coherence. Seven mesh–tissue complexes explanted due to clinically confirmed chronic rejection were analyzed. Histological evaluation (hematoxylin–eosin and Van Gieson staining) was combined with atomic force microscopy (AFM), including topographical imaging, directional analysis, coherence mapping, and roughness quantification according to ISO 25178-2. Histology revealed chronic inflammatory infiltrates, foreign body reaction, and disorganized collagen deposition. AFM analysis showed pronounced surface heterogeneity, fragmented fibrillar architecture, and absence of preferential orientation. Roughness parameters (increased Sa and Sq, elevated Sku, negative Ssk) indicated a structurally irregular surface dominated by depressions and isolated peaks. Directional and coherence analyses confirmed loss of organized fibrillar architecture. These findings suggest that chronic mesh rejection is associated with marked ECM disorganization and loss of structural coherence at the mesh–tissue interface, reflecting impaired tissue integration. Multiscale morphological analysis provides insight into the structural basis of mesh failure and highlights the importance of ECM organization in implant–tissue interactions.