Transforming growth factor beta(2) lowers the incidence of incisional hernias.
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.
Franz
M G
MG
Department of Surgery, University of Michigan, Ann Arbor, Michigan 48105, USA. mfranz@umich.edu
Kuhn
M A
MA
Nguyen
K
K
Wang
X
X
Ko
F
F
Wright
T E
TE
Robson
M C
MC
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
D016212:Transforming Growth Factor beta; D053781:Transforming Growth Factor beta2