The prevention of incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor.
OBJECTIVE
We sought to reduce the high incidence of abdominal wall incisional hernias using sustained release growth factor therapy.


BACKGROUND
Incisional hernias complicate 11% of abdominal wall closures, resulting in 200,000 incisional hernia repairs in the United States each year. Mechanical improvements alone in mesh, suture material, and surgical technique have failed to reduce the high rate of fascial wound failure.


METHODS
Sprague-Dawley rats underwent midline celiotomies that were closed with fast-absorbing suture to induce early biomechanical wound failure and incisional hernia formation. In primary wounds, fascial incisions were closed adjacent to a continuous release polygalactone polymer rod containing basic fibroblast growth factor (bFGF), no growth factor (control-rod), or without rods. In a second group, incisional hernias were repaired with either bFGF or control-rod therapy. Breaking strength was measured on postoperative day (POD) 7, and the incidence of incisional hernia formation was determined on POD 28.


RESULTS
Treatment with bFGF rods significantly increased fascial wound breaking strength. In the "hernia-prevention" experiments, incisional hernias developed in 90% of untreated incisions, 60% of control-rod incisions, and only 30% of bFGF-rod incisions (P < 0.05). In the "hernia-treatment" experiments, recurrent incisional hernias developed in 86% of control-rod incisions compared with only 23% of bFGF-rod treated incisions (P < 0.05). Immunohistochemistry demonstrated increased angiogenesis and collagen protein production in bFGF treated incisions.


CONCLUSIONS
The treatment of abdominal fascial incisions with a sustained-release bFGF polymer significantly lowered the incidence of incisional hernias and the recurrence rate after repair.
Dubay
Derek A
DA
Tissue Repair and Regeneration Laboratory, VA Ann Arbor Health Care System, University of Michigan, Ann Arbor, Michigan, USA.
Wang
Xue
X
Kuhn
M Ann
MA
Robson
Martin C
MC
Franz
Michael G
MG
D000009:Abdominal Muscles / Q000502:physiology; D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001696:Biomechanical Phenomena; D003094:Collagen / Q000096:biosynthesis; D003692:Delayed-Action Preparations; D004337:Drug Carriers; D004343:Drug Implants; D005205:Fascia / Q000378:metabolism / Q000502:physiology; D016222:Fibroblast Growth Factor 2 / Q000008:administration & dosage*; D006555:Hernia, Ventral / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D066298:In Vitro Techniques; D008297:Male; D018919:Neovascularization, Physiologic; D011108:Polymers; D011183:Postoperative Complications / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013718:Tensile Strength; D014945:Wound Healing / Q000187:drug effects
D003692:Delayed-Action Preparations; D004337:Drug Carriers; D004343:Drug Implants; D011108:Polymers; D016222:Fibroblast Growth Factor 2; D003094:Collagen