Abstract
Objective This study was designed to investigate the impact of using suture material impregnated with platelet-rich plasma (PRP) in different platelet concentrations on colonic anastomotic wound healing in rats. Methods A total of 24 Sprague Dawley female rats were separated into 3 groups (n = 8 for each) including the control group (CON; standard vicryl suture repair), the low platelet concentrate PRP group (L-PRP; suture material impregnated with PRP containing average 2.7-fold (range, 2.0 to 3.1) higher amount of platelets vs. control), and the high platelet concentrate PRP group (H-PRP; suture material impregnated with PRP containing average 5.1-fold (range, 4.8 to 5.4) higher amount of platelets vs. control). Rats were sacrificed on the postoperative 7th day for analysis of colonic anastomosis region including macroscopic observation, measurement of anastomotic bursting pressure (ABP), and the hydroxyproline levels and histopathological findings in colon tissue samples. Results Total injury scores were significantly lower in the L-PRP and H-PRP groups than those in the control group (median (range) 13.00 (7.00) and 11.50 (6.00) vs. 15.50 (4.00), p < 0.05 and p < 0.01, respectively). ABP values (180.00 (49.00) vs. 124.00 (62.00) and 121.00 (57.00) mmHg, p < 0.001 for each) and tissue hydroxyproline levels (0.56 (0.37) vs. 0.25 (0.17) and 0.39 (0.10) μg/mg tissue, p < 0.001 and p < 0.05, respectively) were significantly higher in the L-PRP group as compared with those in the control and H-PRP groups. Conclusion In conclusion, our findings revealed PRP application to colonic anastomosis sutures to promote the anastomotic healing process. The platelet concentration of PRP seems to have a significant impact on the outcome with superior efficacy of L-PRP over H-PRP in terms of bursting pressures and collagen concentration at the anastomotic site.
Highlights
Despite marked advances in preoperative management and suture techniques and materials, gastrointestinal anastomotic leakage or dehiscence remains a common complication in colorectal surgery being associated with an increased risk of perioperative morbidity and mortality [1,2,3,4]
The rats were separated into 3 groups (n = 8 for each) including the control group (CON; standard vicryl suture repair), the low platelet concentrate platelet-rich plasma (PRP) group (L-PRP; suture material impregnated with PRP containing average 2.7-fold higher amount of platelets vs. control blood), and the high platelet concentrate PRP group (H-PRP; suture material impregnated with PRP containing average 5.1-fold higher amount of platelets vs. control blood)
LPRP-impregnated sutures and H-PRP-impregnated sutures showed improved lesser total injury scores on histopathological assessment, no significant difference was noted between L-PRP and H-PRP groups in terms of total injury scores related to wound healing when compared to using standard sutures
Summary
Despite marked advances in preoperative management and suture techniques and materials, gastrointestinal anastomotic leakage or dehiscence remains a common complication in colorectal surgery being associated with an increased risk of perioperative morbidity and mortality [1,2,3,4]. This led to a continuing search for innovative methods or technical modifications to avoid anastomotic leakage [5, 6]. The impact of topical use of PRP on the healing of intestinal anastomosis has been addressed in a limited number of rat models which provided controversial results [5, 6, 12,13,14]
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