Dehydrated Human Amniotic-Chorionic Membrane Reduces Incisional Hernia Formation in an Animal Model

Authors

Aran Yoo, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA.
Celia Short, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA.
Mandi J. Lopez, School of Veterinary Medicine, Louisiana State University Baton Rouge, LA.
Catherine Takawira, School of Veterinary Medicine, Louisiana State University Baton Rouge, LA.
Kazi N. Islam, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA.
Patrick Greiffenstein, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA.
Ian Hodgdon, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA. Electronic address: ihodg@lsuhsc.edu.
Denise M. Danos, LSUHSC, Department of Behavioral and Community Health, New Orleans, LA.
Frank H. Lau, Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center-New Orleans New Orleans, LA. Electronic address: flau@lsuhsc.edu.

Document Type

Article

Publication Date

2-1-2022

Abstract

BACKGROUND: Currently there are no standard of care treatment strategies for IH prevention (IHP). Dehydrated human amnion-chorion (dHACM) is a healing adjunct that elutes growth factors including several that have reduced IH in animal models. We therefore performed a double-blinded, prospective randomized controlled trial (RCT) to test the hypothesis that dHACM significantly reduces IH formation in a well-studied animal model of acute IH. MATERIAL AND METHODS: Forty 16-week-old male Sprague-Dawley rats were randomized to one of four groups: No Treatment vs. dHACM Sheet (Group A), and Saline vs. dHACM Injection (Group B). Each animal underwent a 5-cm midline laparotomy which was incompletely closed with 5-0 plain gut sutures; this was performed by a surgeon blinded to treatment group (first blind). After 28 days, the primary endpoints of IH formation and hernia size were determined by study staff blinded to treatment (second blind). Secondary endpoints included healed fascia tensile strength as determined by tensiometry, systemic and local inflammatory markers as measured by ELISA, and fascial scar collagen I/III ratios per Western blotting. RESULTS: In Group A, No Treatment developed IH at 87.5% vs. 62.5% for Sheet (P = 0.28). Hernias that formed in the Sheet group were significantly smaller (P = 0.036). In Group B, Injection and Saline yielded identical IH rates of 77.8%. Molecular characterization of fascial scar demonstrated non-inferior tensile strength, collagen I/III ratios, and inflammatory markers in dHACM-treated animals. CONCLUSIONS: dHACM sheets significantly reduced the size of IH following laparotomy when compared to no treatment.

Publication Source (Journal or Book title)

The Journal of surgical research

First Page

477

Last Page

485

Recommended Citation

Yoo, A., Short, C., Lopez, M. J., Takawira, C., Islam, K. N., Greiffenstein, P., Hodgdon, I., Danos, D. M., & Lau, F. H. (2022). Dehydrated Human Amniotic-Chorionic Membrane Reduces Incisional Hernia Formation in an Animal Model. The Journal of surgical research, 270, 477-485. https://doi.org/10.1016/j.jss.2021.10.019