Platelet rich plasma, adipose tissue micrografts, and regenerative mimetic factors for abdominal wall defect reconstruction: Experimental study protocol.

Abstract

Background: Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice, posing a significant burden on healthcare systems despite advances in education and technology. Surgical techniques, primarily involving the use of mesh to cover the abdominal wall gap, are widely used as a standard intervention strategy.

Aim: To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix [ReGeneraTing Agent (RGTA)], adipose tissue micrografts (ATM), and platelet rich plasma (PRP) as regenerative agents.

Methods: Regenerative agents such as RGTA, ATM, and PRP are gaining popularity. ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells. RGTAs are heparan sulfate (HS) mimetics that replace degraded HSs in damaged tissue, enhancing the quality and speed of repair. PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production. An acellular dermal matrix is a biological implant free of cellular or antigenic components, making it an excellent material for reconstructive surgery. Polyglactin is a synthetic, absorbable mesh that loses 50% of its strength after fourteen days, providing initial support for new tissue regeneration before being completely absorbed.

Results: Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus. They will be divided into sixteen groups, each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments. A collagen-elastin matrix will be used to join the aponeurosis edges, with an absorbable polyglactin mesh anchored over it. Samples will be taken for macroscopic, histological, and immunohistochemical evaluation of tissue regeneration.

Conclusion: Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall, potentially reducing the frequency and complications of incisional hernias. This approach could offer a more economical and efficient treatment option compared to current costly methods.