Abstract
The objective of this study was to investigate the intestinal anastomotic healing enhancing effect of platelets-rich plasma (PRP) using PRP-coated sutures in a rabbit model. A total of 30 mature male rabbits were divided into 3 groups (10 rabbits per group). Group 1 received uncoated sutures, group 2 received sodium acetate-coated sutures, and group 3 received PRP-coated sutures. Polyglactin 910 (Vicryl, USA), size 4-0 was used in all groups. Five rabbits of each group were euthanized on day 3 following the surgery while the remaining 5 rabbits were euthanized on day 10. Gross evaluation of the anastomotic site in PRP-coated sutures group demonstrated significantly (P < 0.05) lower adhesion formation scores on both days 3 and 10 of the study while in the control groups, evidence of leakage at the anastomotic site was present along with signs of haemorrhage and local inflammation. On day 10 in the control groups, there were strands of strong adhesions between the ileum, colon and cecum with large amount of fibrin deposited at the site of the anastomosis. Tissues of the anastomotic site revealed a significant level of hydroxyproline on day 10 in PRP-coated sutures group compared with control groups. Histopathological evaluation revealed significantly (P < 0.05) less inflammatory infiltration, and more angiogenesis and collagen deposition on day 10 in PRP-coated sutures group compared to the control groups. Results of this study clearly indicate promising healing enhancing effects of using PRP-coated sutures at intestinal anastomotic site with little to no obvious disadvantages.
Highlights
Poor wound healing at intestinal anastomotic sites could lead to severe and life-threatening complications, additional surgeries, increased hospital stay and cost, discomfort and increased mortality (Kakudo et al, 2008; Pinto et al, 2016; Garg and Manchanda, 2017; Giusto et al, 2017; Shen et al, 2017)
The platelet derived growth factor (PDGF), transforming growth factor–β (TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and adhesive proteins – fibrin, fibronectin, and vitronectin all have been recognized in the intricate wound healing process (Eppley et al, 2004; Lee et al, 2011; Jain and Gulati, 2016; Alves and Grimalt, 2018)
Hydroxyproline levels in excised tissues from the anastomotic site were analysed on days 3 and 7 of the experiment using spectrophotometer (Hitachi, Japan) according to previously published methods (Ignateva et al, 2007)
Summary
Poor wound healing at intestinal anastomotic sites could lead to severe and life-threatening complications, additional surgeries, increased hospital stay and cost, discomfort and increased mortality (Kakudo et al, 2008; Pinto et al, 2016; Garg and Manchanda, 2017; Giusto et al, 2017; Shen et al, 2017). Several local and systemic factors can result in wound healing disruption leading to increased pain, suffering and sometimes life-threatening complications (Etulain et al, 2018). Substantial evidence suggests that platelet-rich plasma (PRP) enhances wound healing (Akhundov et al, 2012; Alsousou et al, 2013; Jain and Gulati, 2016). The platelet derived growth factor (PDGF), transforming growth factor–β (TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and adhesive proteins – fibrin, fibronectin, and vitronectin all have been recognized in the intricate wound healing process (Eppley et al, 2004; Lee et al, 2011; Jain and Gulati, 2016; Alves and Grimalt, 2018)
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