title: Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model.
abstract: Autologus augmentation of wound remodeling with platelet concentrate is a burgeoning field with promising results. We hypothesized that the addition of filtered platelet concentrate (fPC) to an acellular biologic graft would improve crural healing and tissue integrity in hiatal hernia repair.
  
  
  
  Sixteen healthy Yorkshire female pigs were divided into three groups: hiatus repair (HR) (n = 7), HR with biologic graft (HRM; n = 8, and HR with biologic graft and fPC (fPC; n = 9). Surgeries were performed by a single surgeon. Animals were euthanized at 8 weeks, and the distal esophagus with hiatus was harvested en-block. Tissue was graded by a histopathologist on collagen deposition, vascularization, and inflammation at the graft-hiatal interface. Tensile strength testing was performed using the Teststar IIs (MTS), coupled with a strain extensometer (Epsilon). Samples of equal dimensions were preloaded to 1 N and deformed at a constant rate of 0.2 mm/s. Statistical analysis was performed via Kruskal-Wallis one-way analysis of variance.
  
  
  
  Aspirate analysis revealed a mean platelet count of 3 million platelets/1 mL of aspirate. Animals in the fPC group had significantly increased mean chronic inflammation (3.1 ± 1.1 vs. 1.8 ± 1.6, 1.2 ± 1.2, p = 0.04) compared to HR alone and HR + biologic graft. Vascular deposition did not differ between groups (p = 0.8). A trend toward increased collagen deposition was demonstrated for the fPC group (1.4 ± 1.1 vs. 2.0 ± 0.6 in HR group and 3.0 ± 1.2 in HRM group, p = 0.06). There was a statistically significant increase in tensile strength, yield force, and Young's modulus in the fPC group compared with HR and HR + biologic mesh (p < 0.01).
  
  
  
  A trend toward increased collagen deposition and vascularity of the fPC group was demonstrated. In addition, there was an increase in tensile strength and yield force in the fPC group. Use of autologous fPC appears a safe and promising adjunct to wound remodeling and healing in a swine model.
authors.affiliation: Bariatric Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, 101 Nicolls Road, HSC Tower 18-040, Stony Brook, NY, 11794, USA.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Altieri
authors.affiliation: Department of Biomedical Engineering, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Pagnotti
authors.affiliation: Division of Pathology, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Angelique
authors.initials: A
authors.lastname: Corthals
authors.affiliation: Division of Pathology, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shroyer
authors.affiliation: Bariatric Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, 101 Nicolls Road, HSC Tower 18-040, Stony Brook, NY, 11794, USA.
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
authors.affiliation: Bariatric Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, 101 Nicolls Road, HSC Tower 18-040, Stony Brook, NY, 11794, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Bariatric Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, 101 Nicolls Road, HSC Tower 18-040, Stony Brook, NY, 11794, USA. dtelem@med.umich.edu.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
mesh_terms: D000818:Animals; D001792:Blood Platelets; D004195:Disease Models, Animal; D005260:Female; D006551:Hernia, Hiatal / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059685:Herniorrhaphy / Q000379:methods*; D047589:Leukocyte Reduction Procedures; D015539:Platelet Activation; D017713:Platelet Transfusion / Q000379:methods*; D013552:Swine / Q000601:surgery; D014945:Wound Healing
keywords: Filtered platelet concentrate; Hiatal hernia repair; Swine model