title: Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model.
abstract: Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia repair has reduced their use largely to bridging repair and breast reconstruction. Modalities that improve classic cellular metrics of successful VHR could theoretically result in improved rates of hernia recurrence; autologous platelet-rich plasma (PRP) may represent one such tool, but has been underinvestigated for this purpose.
  
  
  
  Lewis rats (32) had chronic ventral hernias created surgically and then repaired with Strattice™ mesh alone (control) or mesh + autologous PRP. Samples were harvested at 3 and 6 months postoperatively and compared for gross, histologic, and molecular outcomes of: neovascularization, tissue incorporation, peritoneal adhesions, hernia recurrence, and residual mesh thickness.
  
  
  
  Compared to control at 3 months postoperatively, PRP-treated rats displayed significantly more neovascularization of implanted mesh and considerable upregulation of both angiogenic genes (vEGF 2.73-fold, vWF 2.21-fold) and myofibroblastic genes (αSMA 9.68-fold, FSP-1 3.61-fold, Col1a1 3.32-fold, Col31a1 3.29-fold). Histologically, they also showed enhanced tissue deposition/ingrowth and diminished chronic immune cell infiltration. Peritoneal adhesions were less severe at both 3 (1.88 vs. 2.94) and 6 months (1.63 vs. 2.75) by Modified Hopkins Adhesion Scoring. PRP-treated rats experienced decreased hernia recurrence at 6 months (0/10 vs. 7/10) and had significantly improved ADM preservation as evidenced by quantification of residual mesh thickness.
  
  
  
  PRP is an autologous source of pro-regenerative growth factors and chemokines uniquely suited to soft tissue wound healing. When applied to a model of chronic VHR, it incites enhanced angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR.
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.|Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Van Eps
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.|Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Fernandez-Moure
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabrera
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Azim
authors.initials: A
authors.lastname: Karim
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.|Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131, Ancona, Italy.
authors.forename: Bruna
authors.initials: B
authors.lastname: Corradetti
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Paige
authors.initials: P
authors.lastname: Chan
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.|Methodist Institute for Technology, Innovation, and Education (MITIE), Houston Methodist Research Institute, Houston, TX, 77030, USA.|Weill Cornell Medical College, Cornell University, New York, NY, 10021, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Dunkin
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA.
authors.forename: Ennio
authors.initials: E
authors.lastname: Tasciotti
authors.affiliation: Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, TX, 77030, USA. bkweiner@houstonmethodist.org.|Weill Cornell Medical College, Cornell University, New York, NY, 10021, USA. bkweiner@houstonmethodist.org.|Houston Methodist Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA. bkweiner@houstonmethodist.org.
authors.forename: Bradley
authors.initials: B
authors.lastname: Weiner
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.|Weill Cornell Medical College, Cornell University, New York, NY, 10021, USA.
authors.forename: Warren
authors.initials: W
authors.lastname: Ellsworth
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D003094:Collagen; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D008953:Models, Anatomic; D053657:Platelet-Rich Plasma; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D051381:Rats; D011917:Rats, Inbred Lew; D012008:Recurrence; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000453:epidemiology
chemical_list: C568444:strattice; D003094:Collagen
keywords: Hernia; Platelet-rich plasma; Recurrence; Regeneration; Strattice; Ventral hernia repair