The effect of thread implantation on collagen formation and tissue remodeling in the vaginal wall: An experimental porcine study

Title : The effect of thread implantation on collagen formation and tissue remodeling in the vaginal wall: An experimental porcine study

Abstract:

Background. The number of minimally invasive procedures for the functional rejuvenation of the internal genitalia has increased sharply in recent years. Barbed suture threads composed of biodegradable materials represent a promising approach; however, their histological effect on the vaginal wall - as distinct from subcutaneous implantation elsewhere in the body - has not been previously characterized.

Aim and Objectives: To evaluate the effect of three types of implanted barbed suture threads - Light Lift Spring, Excellence Intime, and Excellence Visage - on collagen formation and tissue remodeling in the vaginal wall through experimental histomorphometric analysis at six time points over one year, and to assess the same thread-based approach in a small group of patients.

Methods: Eighteen sexually mature female pigs (Russian White breed, 50-60 kg) were divided into six groups of three. Barbed suture thread products were implanted unilaterally into the vaginal wall. Animals were sacrificed at Days 7, 14, 21, 90, 180, and 360. Tissue specimens were embedded in paraffin, sectioned at 8-10 µm, and stained with hematoxylin-eosin, Weigert-Van Gieson, and Sirius Red. Morphometric parameters - including mucosal and muscular wall thickness, blood vessel diameter, connective tissue area, elastic fiber area, and type I/III collagen ratios - were quantified from 3,195 photomicrographs using GistMorph, ImageView, and Image Tool software. The thread implantation approach was also performed in a small group of patients, who were clinically evaluated to compare the observed effects with the experimental findings.

Results: All three thread types induced statistically significant increases in connective tissue area and neocollagenogenesis compared to controls, with no inflammatory response observed at any time point. Each thread type produced a distinct remodeling profile: Light Lift Spring threads enhanced tissue elasticity and volume; Excellence Intime threads produced stronger fibrogenic stimulation and firmer tissue fixation; Excellence Visage threads demonstrated the most sustained effect on mucosal thickness and type I collagen accumulation. In the patients treated with the same thread-based approach, the observed clinical results followed the same overall pattern and were consistent with the experimental findings.

Conclusions: Barbed suture thread implantation promotes collagen formation and structural remodeling of the vaginal wall without inducing inflammation. The distinct tissue response profiles of different thread types support individualized selection based on patient-specific indications, with potential clinical implications for the management of vaginal laxity and genitourinary syndrome of menopause. The same approach was also applied in a small group of patients, in whom the clinical observations were consistent with the experimental results. Further investigation in larger clinical cohorts is warranted.

Biography:

Irine Megrelishvili, MD, is a physician, lecturer, and medical advisor with a professional focus on obstetrics and gynecology, medical education, and minimally invasive approaches in aesthetic and intimate gynecology. She graduated from David Tvildiani Medical University and is currently pursuing her PhD at Tbilisi State University. Her academic work focuses on uterine leiomyomas, particularly the role of the extracellular matrix and angiogenesis in their development and growth. She has authored and co-authored several scientific publications in this field. Alongside her clinical and research interests, Irine is actively involved in medical education. She has been an invited lecturer at the University of Georgia since 2022 and currently serves as an invited lecturer and Assistant Professor at Caucasus International University. She is also an International Medical Advisor for Aptos, where she previously worked as International Training and Education Manager. Over the years, she has delivered lectures, hands-on workshops, and professional training courses for physicians in Georgia and internationally. Her training activities have taken her to the UAE, Saudi Arabia, Turkey, and Slovakia, with a particular focus on minimally invasive methods in intimate gynecology. Irine has also participated as a speaker at a number of medical conferences and professional meetings, presenting on topics ranging from maternal care and sexually transmitted infections to histological changes following the use of Aptos threads in gynecology.