No abstract

Hernia repair continues to be a problem facing surgeons today, particularly because of the high incidence of reoccurrence. This work presents preliminary data of a pioneering effort to investigate the effect of mesenchymal stromal cells (MSCs) on mechanical property enhancement in full thickness fascial defects. Heparinized MSCs harvested from a rabbit's tibia/iliac crest were applied to two fascial defects on the rabbit's abdominal wall, with two other defects acting as controls (no MSCs added). After an 8 week recovery period, the entire abdominal fascia was harvested for mechanical property testing and elastographic strain analysis. Preliminary results from uniaxial tensile testing indicate a significant increase in the modulus of toughness strain energy, with at least a 50% increase in the MSC treated defects as compared with the control defects. Results from the elastographic strain analysis show excellent correlation in the calibration of the elastography to the uniaxial tensile test, with nearly identical moduli of elasticity. In addition, the elastographs clearly show tissue property heterogeneity at all stages of tensile testing. The MSC treated tissue demonstrates promise of enhanced material properties over that of the nontreated tissue; testing and analysis is ongoing. The elastography provides pixel-level description of tissue property variations providing critical information on wound healing effectiveness that would be impossible with other methods. In the ongoing research, optical elastography, in combination with the traditional tensile test and tissue histology, will be used to characterize localized biomechanical properties directly within the defect area and to locate "crack" initiation and propagation sights as the material is strained to rupture.

The goal of this project is to prevent hernia formation by improving wound healing in surgically repaired tissue. Midline abdominal incisions were performed on Lewis rats. In Group 1 (n=14) the incision was repaired with no further additions. Group 2 had PRP on a collagen matrix (CollaTape™, Zimmer Dental) applied to the repaired incision. Group 3 received the same treatment as Group 2 with the addition of 106 MSC. The biomechanical properties of the facial defects, including the control samples, were determined using a standard force‐extension tensiometric analysis after 4 weeks (n=7) or 8 weeks (n=7). Tissues from Group 1 had an average tensile strength of 204 kPa at four weeks and 421.83 kPa at eight weeks; Group 2 at four weeks was 409.58 kPa and 582.18 kPa at eight weeks; Group 3 at four weeks was 817.15 kPa and at eight weeks was 917.17 kPa. Marked improvement in healing was seen with PRP, which was further improved by the addition of MSC. Supported by St. Elizabeth Health Center, Youngstown State University and LifeCell Hernia Resident/Fellow Research Grant.

Hernia repair continues to be one of the major problems faced by surgeons. Up to 10% of laparotomies are complicated by post-operative incisional hernia, carrying with it a myriad of complications ranging from cosmetic disfigurement to life-threatening strangulation of the bowel [1]. A large percentage of these incisional hernias will recur following surgical repair leading to a more vicious cycle of hernia, followed by repair, followed by hernia. It is therefore imperative to create a more optimum wound-healing environment. The intent of this study was to investigate a novel approach for significantly reducing the initial occurrence of incisional hernia and their associated morbidities, thereby halting the vicious cycle of hernia formation.