title: Bone marrow-derived mesenchymal stromal cells and platelet-rich plasma on a collagen matrix to improve fascial healing.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Division of Acute Care Surgery, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. bigheff11@yahoo.com
authors: J J
authors: JJ
authors: Heffner
authors: J W
authors: JW
authors: Holmes
authors: J P
authors: JP
authors: Ferrari
authors: J
authors: J
authors: Krontiris-Litowitz
authors: H
authors: H
authors: Marie
authors: D L
authors: DL
authors: Fagan
authors: J C
authors: JC
authors: Perko
authors: H A
authors: HA
authors: Dorion
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000704:Analysis of Variance; D000818:Animals; D003094:Collagen / Q000627:therapeutic use*; D055119:Elastic Modulus; D005205:Fascia / Q000033:anatomy & histology / Q000502:physiology*; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D032342:Muscle Cells / Q000473:pathology; D018919:Neovascularization, Physiologic; D053657:Platelet-Rich Plasma; D051381:Rats; D011917:Rats, Inbred Lew; D013718:Tensile Strength; D014945:Wound Healing
chemical_list: D003094:Collagen