title: Augmenting myometrial healing after cesarean delivery: use of an adjuvant biologic graft placement in an ovine model.
abstract: We sought to reduce long-term complications after cesarean delivery by improving myometrial healing. Eight sheep (three with twins) underwent cesarean delivery. Hysterotomy sites were repaired in equal parts by suture alone or suture with a juxtaposed graft (Cook Medical, Bloomington, IN). At 90 days postsurgery, scar characteristics and tensile strength testing were assessed. The mean hysterotomy closure time was on average 1 minute, 14 seconds longer for those undergoing graft placement ( P=0.36). The mean scar thickness was 3.0 ± 0.4 mm for controls versus 3.8 ± 1.2 mm for the intervention group ( P=0.047). Tensile strength testing did not demonstrate a significant difference between groups. Histological examination of the myometrial scar showed no significant differences in inflammatory reaction or endometrial inclusions; however, neoangiogenesis was significantly enhanced. Myometrial repair incorporating a graft increased scar thickness and neoangiogenesis. This methodology did not incite adenomyosis or enhance inflammation within the scar.
authors.affiliation: Maternal Fetal Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA. john.obrien2@uky.edu
authors.forename: John M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Daniel
authors.initials: D
authors.lastname: Whetham
authors.forename: Christopher
authors.initials: C
authors.lastname: Fecteau
authors.forename: John
authors.initials: J
authors.lastname: Jansen
authors.forename: Michael
authors.initials: M
authors.lastname: Hiles
mesh_terms: D000818:Animals; D002585:Cesarean Section; D002921:Cicatrix / Q000473:pathology; D005260:Female; D020883:Hysterotomy; D007413:Intestinal Mucosa / Q000637:transplantation*; D023421:Models, Animal; D009215:Myometrium / Q000502:physiology* / Q000601:surgery; D011247:Pregnancy; D012756:Sheep; D013718:Tensile Strength; D000267:Tissue Adhesions; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000502:physiology