title: Transforming growth factor beta(2) lowers the incidence of incisional hernias.
abstract: BACKGROUND
  Approximately 200,000 incisional hernias are repaired annually in the United States. The high incidence (11-20%) and recurrence rate (24-54%) for incisional hernias have not changed appreciably in 75 years. Mechanical advances in suture material, incision orientation, and closure technique have failed to eliminate this common surgical complication. A biological approach to acute wound failure may offer a new strategy.
  
  
  METHODS
  A rodent incisional hernia model was used. Seventy rats underwent 5-cm midline celiotomies and were closed with fine, fast-absorbing sutures to induce intentional acute wound failure. Group 1 received no other treatment. The midline fascia in groups 2 and 3 was injected immediately prior to incision with 100 microl of vehicle alone or vehicle containing 1 microg of transforming growth factor beta(2) (TGF-beta(2)). Necropsy was performed on Postoperative Day 28 and the wounds were examined for herniation.
  
  
  RESULTS
  Incisional hernias developed in 88% (35/40) and 79% (11/14) of untreated incisions and those treated with vehicle alone. No hernias formed in the TGF-beta(2)-treated incisions (0/16, P < 0.05). Standard histology and immunohistochemistry demonstrated enhanced macrophage, lymphocyte, and fibroblast chemotaxis and increased collagen I and III production in TGF-beta(2) treated incisions.
  
  
  CONCLUSIONS
  Treatment of abdominal wall fascial incisions with TGF-beta(2) prevented the development of incisional hernias in this rat model. TGF-beta(2) stimulated fascial macrophage and fibroblast chemotaxis as well as acute wound collagen production. A biological approach such as this may reduce the incidence of incisional hernia formation in humans.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan 48105, USA. mfranz@umich.edu
authors.forename: M G
authors.initials: MG
authors.lastname: Franz
authors.forename: M A
authors.initials: MA
authors.lastname: Kuhn
authors.forename: K
authors.initials: K
authors.lastname: Nguyen
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: F
authors.initials: F
authors.lastname: Ko
authors.forename: T E
authors.initials: TE
authors.lastname: Wright
authors.forename: M C
authors.initials: MC
authors.lastname: Robson
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D000818:Animals; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D016212:Transforming Growth Factor beta / Q000494:pharmacology*; D053781:Transforming Growth Factor beta2; D014945:Wound Healing / Q000187:drug effects
chemical_list: D016212:Transforming Growth Factor beta; D053781:Transforming Growth Factor beta2