Challenging abdominal incisional hernia repaired with platelet-rich plasma and bone marrow-derived mesenchymal stromal cells. A case report. (2017)

• Record Type: Journal Article
• Authors: Palini, Gian Marco; Morganti, Lucia; Paratore, Filippo; Coccolini, Federico; Crescentini, Giacomo; Nardi, Matteo; Veneroni, Luigi
• Is Part Of: International journal of surgery case reports. Volume 37(2017)
• Page Start: 145
• Page End: 148
• Publication Date: 2017
• Subjects: AIH abdominal incisional hernia -- EF enterocutaneous fistula -- PRP platelet-rich plasma -- BM-MSCs bone marrow-derived mesenchymal stromal cells -- CECT contrast enhanced computed tomography -- ICU Intensive Care Unit -- VEGF vascular endothelial growth factor -- PDGF platelet-derived growth factor -- TGF transforming growth factors -- FGF fibroblast growth factors -- EGF epidermal growth factor; Abdominal hernia -- Incisional hernia -- Tissue engineering -- Platelet rich plasma -- Intestinal fistula -- Wound healing; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.06.005
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: New treatment options for challenging procedures in hernia surgery are necessary. Possibility of improving prosthetic compatibility and reducing future recurrences. Tissue engineering offers new strategies to improve fascial healing. Case of a surgeon – challenging abdominal incisional hernia. Treatment provided was PRP and BM-MSCs on a biological mesh. Abstract: Introduction: The necessity to develop new treatment options for challenging procedures in hernia surgery is becoming even more evident and tissue engineering and biological technologies offer even newer strategies to improve fascial healing. The present case reports a patient-tailored surgical technique performed to repair a grade IV abdominal incisional hernia, with a combined use of platelet-rich plasma and bone marrow-derived mesenchymal stromal cells, implanted on a biological mesh. Presentation of the case: A 71 year-old female patient complained of an abdominal incisional hernia, complicated by enterocutaneous fistula, four-months following laparostomy. Contrast enhanced computed tomography showed an incisional hernia defect of 15.5 × 20 cm, with a subcutaneous abscess and an intestinal loop adherent to the anterior abdominal wall, with a concomitant enterocutaneous fistula. Surgery involved abdominal wall standardized technique closure, with in addition platelet-rich plasma and bone marrow-derived mesenchymal stromal cells implanted on a biological mesh. Two years follow up showed no recurrences of incisional hernia. Discussion: Coating surgical meshes with patient's own cells may improve biocompatibility, by reducing inflammation and adhesion formation. Moreover, platelet-rich plasma is a good source of growth factors for wound healing, as well as a good medium for bone marrow multinucleate cells introduction into fascial repair. Conclusion: This approach is likely to improve abdominal wall repair in high grade (IV) incisional hernia, with the real possibility of improving prosthetic compatibility and reducing future recurrences. The authors agree with the necessity of further studies and trials to assure the safety profile and superiority of this procedure.