ABSTRACT
OBJECTIVE: To demonstrate improved healing of a midline laparotomy after application of mesenchymal stromal cells and platelet-rich plasma on a collagen matrix and introduce a potential cellular-based therapy for the prevention of incisional hernia formation. BACKGROUND: Up to 10 % of laparotomies are complicated by postoperative incisional hernias. Despite continuous improvements in surgical technique and technology, hernia rates have remained constant. Cell-based therapies focused on augmentation of the body's natural healing properties could reduce hernia formation. METHODS: Midline laparotomies were performed on 42 Lewis rats. Three groups were studied: (1) primary repair only, (2) primary repair with CollaTape™ (CoTa) overlay and platelet-rich plasma (PRP), and (3) primary repair with CoTa overlay and PRP and bone marrow-derived mesenchymal stromal cells (BM-MSCs). Abdominal wall fascia was recovered at 4 and 8 weeks in each group. Biomechanical testing and histological evaluation was performed. RESULTS: At 4 weeks, there was a twofold increase in tensile strength between groups 1 and 2 and a fourfold increase between groups 1 and 3 (p < 0.001). Group 3 had a 320 % increase in total energy absorption at 4 weeks compared to group 1 and a 142 % increase at 8 weeks (p < 0.001). Vascularization and collagen abundance were significantly increased in group 3 at both time points. CONCLUSION: The addition of BM-MSCs, PRP, and CoTa led to a marked improvement in abdominal wall strength and energy absorption. Histologic evaluation confirmed increased vascularity and collagen abundance consistent with the biomechanical findings. Application of this therapy may ultimately reduce incisional hernia formation.
