Vitamin C, collagen metabolism, and incisional hernia formation: a translational narrative review

Abstract Introduction Vitamin C is required for collagen hydroxylation and maturation, whereas incisional hernia is repeatedly associated with extracellular-matrix and collagen-turnover abnormalities. This narrative review evaluates how securely these two evidence domains can be connected and defines the clinical hypothesis that remains untested. Content The literature was reviewed across biochemical, cellular, human tissue, perioperative, wound-healing, and hernia-focused studies. Human evidence was prioritized; in vitro and animal studies were retained only as mechanistic or proof-of-principle evidence. Particular attention was given to perioperative vitamin C depletion and to separating association from causation. Summary Ascorbate has an established biochemical role in collagen maturation and modulates fibroblast matrix production. Human incisional-hernia studies report altered collagen composition, turnover biomarkers, fibroblast phenotypes, and extracellular-matrix signatures, although findings are heterogeneous across tissues. A meta-analysis found a mean first-week postoperative plasma/serum vitamin C decrease of 17.99 μmol/L, corresponding to about 39 %. Inguinal-hernia data from a small randomized trial show that a multinutrient intervention containing vitamin C can augment selected early collagen-synthesis markers, but the effect cannot be attributed to vitamin C alone. Direct abdominal-wall evidence for vitamin C is preclinical. No identified human study has directly linked vitamin C status, fascial collagen biology, and subsequent incisional-hernia outcomes. Outlook Prospective studies should test whether low preoperative vitamin C status or a pronounced postoperative decline is associated with adverse fascial matrix phenotypes and later incisional hernia before supplementation is evaluated preventively.