Introduction



Title: Turnover Flap of External Rectus Sheath as Autologous Graft for Correction of Scrotal Hernia in RamsAuthors: Ahmed Khalil1*, Mohamed Zeineldin2, 3, Mohamed Ramadan 4 and Atef Abd Al-Galil 51Department of Veterinary Surgery, Anesthesiology and Radiology, College of Veterinary Medicine,?Benha University,?Benha, Egypt.?2Department of Animal Medicine, College of Veterinary Medicine,?Benha University,?Benha, Egypt.3Carl R. Woese Institute of Genomic Biology, Infectious Genomic of One Health (IGOH), University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.?4Department of Animal Medicine, College of Veterinary Medicine,?Benha University,?Benha, Egypt.5 Department of Veterinary Surgery, Anesthesiology and Radiology, College of Veterinary Medicine,?Monofia University,?Shebin El-Kom, Egypt?*Corresponding author: Ahmed H. Khalil, Department of Surgery, Anesthesiology and Radiology, College of Veterinary Medicine,?Benha University,?Benha, Egypt Email: ahmed.Khalil@fvtm.bu.edu.egABSTRACT The objective of this study was to evaluate the outcomes of external rectus sheath (ERF) turnover flap with and without platelet-rich plasma (PRP) for reconstruction of large scrotal hernia in ram. A total of 13 baladi rams suffered from large sized unilateral voluminous scrotal swelling were used in this study. All rams were randomly allocated into two groups according to the type of surgical interference; group ERF (n=6) were subjected to surgical correction by external rectus sheath turnover flap and group ERF-PRP (n=7) were subjected to surgical correction by ERF with PRP. The scrotal hernia was successfully corrected, and the graft turnover procedure was easily carried out in all rams in both groups. Clinical assessment of pain and heat in ERF-PRP depicted the lowest score at all time points compared to ERF group. Hematological analyses showed significant changes in white blood cells, neutrophil, lymphocytes, eosinophils, basophils count, serum amyloid A, haptoglobin, tumor necrosis factor-α and interlukin-1β in ERF-PRP group (lower) when compared to ERF group at days 3 and 7 after conduction of surgical correction. Ultrasonographic examination of all rams in the ERF and ERF-PRP groups showed that the graft was fixed and correctly positioned. Ultrasound color doppler recorded higher vascularity in ERF-PRP in the form of a high-color signal at lateral margin of turnover flap at days 7, 21 and 35-days post-operative. Conclusively, autologous grafting with external rectus sheath flap with PRP, is a simple procedure, with low cost, fewer adhesion and no short-term complications. Keywords: Grafting; Hernia; Hernioplasty; Rams; Scrotal.Introduction Surgical treatment of large abdominal wall defects and their complications in ruminant remains an area of debate. Scrotal hernia accounts for approximately 23.5 percent of common abdominal wall defects in small ruminants and has several detrimental impacts ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1308/003588406X95093","ISSN":"00358843","abstract":"Introduction: There is a commonly held belief that the development of a hernia can be attributed to a single strenuous or traumatic event. Hence, many litigants are successful in compensation claims, causing mounting financial burdens on employers, the courts, insurance companies and the tax-payer. However, there is very little scientific evidence to support this assertion. The aim of this study was to ascertain whether there was any causal link in this process. Patients and methods: A tota l of 133 new patients with 135 abdominal herniae of all varieties (115 inguinal, 3 femoral, 9 umbilical, 4 incisional, and 4 ventral or epigastric), of which 25 were recurrent received structured questionnaires on arrival in the surgical clinic. These questionnaires covered all possible aetiological factors for hernia development (type of work, COAD, smoking, pregnancy, obesity, chronic bladder outflow obstruction, previous surgery including appendicectomy), in addition to any possible attribution to a single strenuous or traumatic event. We then reviewed the GP records in the surgery of all patients who answered positively to the latter possible cause. Results: In the study group, 119 (89%) reported a gradual onset of symptoms. Of the 15 (12 male, 3 female; 11%) who believed that their hernia might be related to a single strenuous or traumatic event, 5 had no other aetiological factors. However, not one of the 15 was found to have contemporaneous forensic medical evidence to support their possible claim. Conclusions: We conclude that we are unable to find any clinical evidence to support the hypothesis that a hernia might develop as the result of one single strenuous or traumatic event. While we accept that this mechanism might still possibly occur, we believe that, at best, it is extremely uncommon. If a medical expert is preparing a report on such a case in a claim for personal injury, then they have a duty to the court to examine carefully all the contemporaneous medical records. If no clinical evidence exists to support the claim, then they have a duty to the court not to support the plaintiff's claim.","author":[{"dropping-particle":"","family":"Pathak","given":"Samir","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Poston","given":"Graeme J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Annals of the Royal College of Surgeons of England","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2006"]]},"page":"168-171","title":"It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenous event","type":"article-journal","volume":"88"},"uris":[""]}],"mendeley":{"formattedCitation":"(Pathak and Poston, 2006)","plainTextFormattedCitation":"(Pathak and Poston, 2006)","previouslyFormattedCitation":"[26]"},"properties":{"noteIndex":0},"schema":""}(Pathak and Poston, 2006; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/1751-0147-55-27","ISSN":"17510147","abstract":"BACKGROUND: The rates of congenital disorders in Swiss sheep were determined by a questionnaire which was sent to 3,183 members of the Swiss Sheep Breeders' Association.\nFINDINGS: A total of 993 questionnaires were returned, giving a response rate of 31.2%. Of these, 862 questionnaires originated from farms keeping one of the predominant Swiss sheep breeds: Swiss White Alpine sheep, Brown-Headed Meat sheep, Swiss Black Brown Mountain sheep and Valais Blacknose sheep. During a 10-year-period, entropion was reported in 33.6% of the farms, brachygnathia inferior in 29.5%, abdominal/umbilical hernia in 15.9%, cryptorchidism in 10.5% and torticollis in 10.5%. The most significant difference between the four breeds (P<0.001) occurred for entropion in Swiss White Alpine sheep and Brown-Headed Meat sheep, brachygnathia inferior in Swiss Black Brown Mountain sheep, and scrotal/inguinal hernia in Valais Blacknose sheep. The Swiss White Alpine breed showed a significantly higher animal prevalence of entropion (6.2% in 2011 and 5.5% in 2012) than other breeds (P<0.001).\nCONCLUSIONS: These findings indicate a breed-specific necessity for action, particularly regarding Swiss animal welfare legislation, especially entropion in Swiss White Alpine sheep is concerned. In general, careful selection of breeding stock is to be recommended.","author":[{"dropping-particle":"","family":"Greber","given":"Deborah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Doherr","given":"Marcus","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dr?gemüller","given":"Cord","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Steiner","given":"Adrian","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta veterinaria Scandinavica","id":"ITEM-1","issued":{"date-parts":[["2013"]]},"page":"27","title":"Occurrence of congenital disorders in Swiss sheep","type":"article-journal","volume":"55"},"uris":[""]}],"mendeley":{"formattedCitation":"(Greber et al., 2013)","plainTextFormattedCitation":"(Greber et al., 2013)","previouslyFormattedCitation":"[14]"},"properties":{"noteIndex":0},"schema":""}Greber et al., 2013). Scrotal hernia correction through surgical intervention experienced many complications, including dehiscence, rapture, seroma, mesh extrusion, enterocutaneous fistula, erosion, adhesion, contraction, and recurrence ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4240/wjgs.v7.i12.384","ISSN":"1948-9366","abstract":"AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.\\n\\nMETHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients (13.9%) died and 12 (6.2%) failed to attend their follow-up appointment. One hundred and fifty-three (78.9%) patients attended for follow-up and two patients (1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82 (52.9%) patients had received laparoscopic ventral hernia mesh repair (LVHR) while 73 (47.1%) patients had undergone open ventral hernia mesh repair (OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale (VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.\\n\\nRESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain (VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.\\n\\nCONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.","author":[{"dropping-particle":"","family":"Langbach","given":"Odd","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"World Journal of Gastrointestinal Surgery","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2015"]]},"page":"384","title":"Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair","type":"article-journal","volume":"7"},"uris":[""]}],"mendeley":{"formattedCitation":"(Langbach, 2015)","plainTextFormattedCitation":"(Langbach, 2015)","previouslyFormattedCitation":"[20]"},"properties":{"noteIndex":0},"schema":""}(Langbach, 2015; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1089/sur.2017.154","ISSN":"15578674","abstract":"Background: Inguinal hernias are a common disorder in low- and middle-human development index countries (LMHDICs). Poor access to surgical care and lack of patient awareness often lead to delayed presentations of incarcerated or strangulated hernias and their associated morbidities. There is a scarcity of data on the baseline incidence of surgical site infections (SSIs) after hernia repair procedures in LMHDICs. Methods: We performed a systematic review of the literature describing the incidence and management of SSIs after inguinal hernia repair in LMHDICs. We conducted qualitative and quantitative analyses of manuscripts describing patients undergoing hernia repair to establish a baseline SSI rate for this procedure in these settings. Results: Three hundred twenty-three abstracts were identified after applying search criteria, and 31 were suitable for the quantitative analysis. The overall pooled SSI rate was 4.1 infections/100 open hernia repairs (95% confidence interval [CI] 3.0-5.3 infections/100 open repairs), which is consistent with infection rates from high-human development index countries. A separate subgroup analysis of laparoscopic hernia repairs found a weighted pooled SSI rate of 0.4 infections/100 laparoscopic repairs (95% CI 0-2.4 infections/100 laparoscopic repairs). Conclusions: As surgical access continues to expand in LMHDIC settings, it is imperative to monitor surgical outcomes and ensure that care is provided safely. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in these countries.","author":[{"dropping-particle":"","family":"Cai","given":"Lawrence Z.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Foster","given":"Deshka","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kethman","given":"William C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weiser","given":"Thomas G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Forrester","given":"Joseph D.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Infections","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2018"]]},"page":"11-20","title":"Surgical Site Infections after Inguinal Hernia Repairs Performed in Low and Middle Human Development Index Countries: A Systematic Review","type":"article-journal","volume":"19"},"uris":[""]}],"mendeley":{"formattedCitation":"(Cai et al., 2018)","plainTextFormattedCitation":"(Cai et al., 2018)","previouslyFormattedCitation":"[5]"},"properties":{"noteIndex":0},"schema":""}Cai et al., 2018; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/jscr/rjz251","ISSN":"2042-8812","abstract":"The use of Prolene mesh for repair of various hernias is very common. As with any surgical procedure, it can be associated with complications such as seroma, hematoma and wound infection. However, it is uncommon to develop heterotopic ossification following incisional hernia repair with Prolene mesh. Herein, we report a case with chronic abdominal pain secondary to heterotopic ossification occurring after incisional hernia repair with Prolene mesh. It is crucial to report uncommon reactions to the mesh in order to aid in diagnosis of unexplained abdominal pain post hernia repair, after common etiologies are ruled out.","author":[{"dropping-particle":"","family":"Nasralla","given":"Awrad","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Bonnie","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Surgical Case Reports","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2019"]]},"page":"1-3","title":"Unusual osseous metaplasia following hernia repair with Prolene mesh: a case report","type":"article-journal","volume":"2019"},"uris":[""]}],"mendeley":{"formattedCitation":"(Nasralla and Tsang, 2019)","plainTextFormattedCitation":"(Nasralla and Tsang, 2019)","previouslyFormattedCitation":"[25]"},"properties":{"noteIndex":0},"schema":""}Nasralla and Tsang, 2019). Recently, autografting has been widely used in human and veterinary practice to correct various abdominal defects ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3393/ac.2014.30.4.197","ISSN":"22879722","abstract":"A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.","author":[{"dropping-particle":"","family":"Lee","given":"Taek Gu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Sang Jeon","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Annals of Coloproctology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2014"]]},"page":"197-200","title":"Mesh-based transperineal repair of a perineal hernia after a laparoscopic abdominoperineal resection","type":"article-journal","volume":"30"},"uris":[""]}],"mendeley":{"formattedCitation":"(Lee and Lee, 2014)","plainTextFormattedCitation":"(Lee and Lee, 2014)","previouslyFormattedCitation":"[21]"},"properties":{"noteIndex":0},"schema":""}(Lee and Lee, 2014). Autografting showed promising results, including battling infection, high healing rate, decreased adhesion and contraction ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1292/jvms.11-0478","ISSN":"09167250","abstract":"Perineal hernia in dogs is very problematic and mostly requires surgical reconstruction of the weak pelvic diaphragm. Tissue or synthetic grafts have been used for the correction after failure of the conventional herniorrhaphy. Aim of this clinical trial was to assess the possible use of the autologous tunica vaginalis communis as a free graft for perineal hernia repair in intact male dogs. Seven unilateral and 2 bilateral perineal hernias in nine intact male dogs free from testicular and scrotal neoplasms were included in this study. The median surgical time for unilateral herniorrhaphy was 75 min. The median follow-up time was 13 months. The success of the autografting, based on no recurrence and comfort of the animals during urination and defecation, was found in ten of 11 hernias; giving a success rate of 90.91%. One hernia (9.09%) recurred 10 days after surgery. Histopathological examination of the apposing area between the graft and the adjacent tissue, taken during the repair of the recurred case at day 20, revealed neovascularization and connective tissue ingrowth. In conclusion, the tunica vaginalis autograft can be used for perineal herniorrhaphy in intact male dogs. ? 2013 The Japanese Society of Veterinary Science.","author":[{"dropping-particle":"","family":"Pratummintra","given":"Kittiya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chuthatep","given":"Suwicha","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banlunara","given":"Wijit","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalpravidh","given":"Marissak","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Veterinary Medical Science","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2013"]]},"page":"337-341","title":"Perineal hernia repair using an autologous tunica vaginalis communis in nine intact male dogs","type":"article-journal","volume":"75"},"uris":[""]}],"mendeley":{"formattedCitation":"(Pratummintra et al., 2013)","plainTextFormattedCitation":"(Pratummintra et al., 2013)","previouslyFormattedCitation":"[27]"},"properties":{"noteIndex":0},"schema":""}(Pratummintra et al., 2013; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.17479/jacs.2014.4.1.31","ISSN":"2288-9582","author":[{"dropping-particle":"","family":"Jang","given":"Ji Young","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Hongjin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Seung Hwan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jae Gil","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Acute Care Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2014"]]},"page":"31-34","title":"Anterior Rectus Sheath Turnover Method for Abdominal Wall Reconstruction and Enterostomy Formation in Patient with Intra-abdominal Infection due to Anastomotic Leakage","type":"article-journal","volume":"4"},"uris":[""]}],"mendeley":{"formattedCitation":"(Jang et al., 2014)","plainTextFormattedCitation":"(Jang et al., 2014)","previouslyFormattedCitation":"[16]"},"properties":{"noteIndex":0},"schema":""}Jang et al., 2014). The most frequently used loco-regional flaps in autografting involves external oblique muscle, tensor fascia lata, rectus abdominis muscle, rectus femoris muscle, latissimus dorsi muscle, omental flaps and tunical vaginalis ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.17479/jacs.2014.4.1.31","ISSN":"2288-9582","author":[{"dropping-particle":"","family":"Jang","given":"Ji Young","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Hongjin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Seung Hwan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jae Gil","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Acute Care Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2014"]]},"page":"31-34","title":"Anterior Rectus Sheath Turnover Method for Abdominal Wall Reconstruction and Enterostomy Formation in Patient with Intra-abdominal Infection due to Anastomotic Leakage","type":"article-journal","volume":"4"},"uris":[""]}],"mendeley":{"formattedCitation":"(Jang et al., 2014)","plainTextFormattedCitation":"(Jang et al., 2014)","previouslyFormattedCitation":"[16]"},"properties":{"noteIndex":0},"schema":""}(Jang et al., 2014). Although scarce literature addressed the usefulness of autografting in veterinary surgery (Abdelwahed et al. 2012), the anterior rectus sheath turnover flap was used to repair large abdominal defects in human surgery ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00268-006-0282-3","ISSN":"03642313","abstract":"Background: Many patients requiring conventional open abdominal management need a postoperative intermediate period with a large ventral hernia. This situation, in which the granulated abdominal contents are covered only with a skin graft, carry with it a high risk of enterocutaneous fistula, and the patients ultimately require late-stage abdominal wall reconstruction. Early abdominal wall reconstruction in noncandidates for standard fascial closure has received little attention. In this study we used bilateral anterior rectus abdominis sheath turnover flaps for early fascial closure which, to date, has not been evaluated as a technique for early fascial closure. Methods: Eleven trauma and 18 nontrauma cases requiring open abdominal management over a 7-year period were reviewed. Bilateral anterior rectus abdominis sheath turnover flaps were created by longitudinal incisions along the lateral edge of the anterior rectus sheath, which were mobilized medially and approximated. The skin was closed primarily. Results: Twelve nontrauma and eight trauma patients survived. No enteric fistula or abdominal abscess occurred. Anterior rectus sheath turnover flaps were used in nine of the 18 nontrauma and two of the 11 trauma patients, all of whom were unsuitable for standard fascial closure of prolonged visceral edema; the respective mean intervals from initial laparotomy to fascial closure were 9.4 and 18 days. Of the 11 patients with flaps, ten survived without fascial dehiscence or herniation (maximum follow-up: 65 months). Conclusions: Early fascial closure using the anterior rectus abdominis sheath turnover flap may reduce the need for skin grafting and subsequent abdominal wall reconstruction. This approach can be considered as an alternative technique in the early management of patients with open abdomen. ? 2006 Société Internationale de Chirurgie.","author":[{"dropping-particle":"","family":"Kushimoto","given":"Shigeki","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamamoto","given":"Yasuhiro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aiboshi","given":"Junichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ogawa","given":"Futoshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koido","given":"Yuichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yoshida","given":"Ryusuke","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kawai","given":"Makato","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"World Journal of Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2007"]]},"page":"2-8","title":"Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management","type":"article-journal","volume":"31"},"uris":[""]}],"mendeley":{"formattedCitation":"(Kushimoto et al., 2007)","plainTextFormattedCitation":"(Kushimoto et al., 2007)","previouslyFormattedCitation":"[18]"},"properties":{"noteIndex":0},"schema":""}(Kushimoto et al., 2007). Increasing response of tissue and graft incorporation after autografting was achieved through the use of various forms of plasma products as growth factor source. The use of plasma products acts as a scaffold for formation of new fibrovascular tissues and consequently improved mechanical strength, and reduced hernia recurrence incidence ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1097/01.sla.0000131576.12153.ab","ISSN":"00034932","abstract":"Objective: We sought to reduce the high incidence of abdominal wall incisional hernias using sustained release growth factor therapy. Summary Background Data: Incisional hernias complicate 11% of abdominal wall closures, resulting in 200,000 incisional hernia repairs in the United States each year. Mechanical improvements alone in mesh, suture material, and surgical technique have failed to reduce the high rate of fascial wound failure. Methods: Sprague-Dawley rats underwent midline celiotomies that were closed with fast-absorbing suture to induce early biomechanical wound failure and incisional hernia formation. In primary wounds, fascial incisions were closed adjacent to a continuous release polygalactone polymer rod containing basic fibroblast growth factor (bFGF), no growth factor (control-rod), or without rods. In a second group, incisional hernias were repaired with either bFGF or control-rod therapy. Breaking strength was measured on postoperative day (POD) 7, and the incidence of incisional hernia formation was determined on POD 28. Results: Treatment with bFGF rods significantly increased fascial wound breaking strength. In the \"hernia-prevention\" experiments, incisional hernias developed in 90% of untreated incisions, 60% of control-rod incisions, and only 30% of bFGF-rod incisions (P < 0.05). In the \"hernia-treatment\" experiments, recurrent incisional hernias developed in 86% of control-rod incisions compared with only 23% of bFGF-rod treated incisions (P < 0.05). Immunohistochemistry demonstrated increased angiogenesis and collagen protein production in bFGF treated incisions. Conclusion: The treatment of abdominal fascial incisions with a sustained-release bFGF polymer significantly lowered the incidence of incisional hernias and the recurrence rate after repair.","author":[{"dropping-particle":"","family":"Dubay","given":"Derek A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Xue","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kuhn","given":"M. Ann","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Robson","given":"Martin C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Franz","given":"Michael G.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Annals of Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2004"]]},"page":"179-186","title":"The prevention of incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor","type":"article-journal","volume":"240"},"uris":[""]}],"mendeley":{"formattedCitation":"(Dubay et al., 2004)","plainTextFormattedCitation":"(Dubay et al., 2004)","previouslyFormattedCitation":"[8]"},"properties":{"noteIndex":0},"schema":""}(Dubay et al., 2004; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1302/0301-620X.89B3.18491","ISSN":"0301620X","abstract":"Platelet-rich plasma is a new inductive therapy which is being increasingly used for the treatment of the complications of bone healing, such as infection and nonunion. The activator for platelet-rich plasma is a mixture of thrombin and calcium chloride which produces a platelet-rich gel. We analysed the antibacterial effect of platelet-rich gel in vitro by using the platelet-rich plasma samples of 20 volunteers. In vitro laboratory susceptibility to platelet-rich gel was determined by the Kirby-Bauer disc-diffusion method. Baseline antimicrobial activity was assessed by measuring the zones of inhibition on agar plates coated with selected bacterial strains. Zones of inhibition produced by platelet-rich gel ranged between 6 mm and 24 mm (mean 9.83 mm) in diameter. Platelet-rich gel inhibited the growth of Staphylococcus aureus and was also active against Escherichia coli. There was no activity against Klebsiella pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa. Moreover, platelet-rich gel seemed to induce the in vitro growth of Ps. aeruginosa, suggesting that it may cause an exacerbation of infections with this organism. We believe that a combination of the inductive and antimicrobial properties of platelet-rich gel can improve the treatment of infected delayed healing and nonunion. ? 2007 British Editorial Society of Bone and Joint Surgery.","author":[{"dropping-particle":"","family":"Bielecki","given":"Tomek M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gazdzik","given":"T. S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Arendt","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Szczepanski","given":"T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Król","given":"W.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wielkoszynski","given":"T.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Bone and Joint Surgery - Series B","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2007"]]},"page":"417-420","title":"Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: An in vitro study","type":"article-journal","volume":"89"},"uris":[""]}],"mendeley":{"formattedCitation":"(Bielecki et al., 2007)","plainTextFormattedCitation":"(Bielecki et al., 2007)","previouslyFormattedCitation":"[3]"},"properties":{"noteIndex":0},"schema":""}Bielecki et al., 2007). One of the widely used plasma products in autografting is platelet-rich plasma (PRP), which considered a rich source of several growth factors including: platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), growth factor insulin (IGF) and hepatocyte growth factor (HGF) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/s13075-015-0691-5","ISSN":"14786362","abstract":"Introduction: The relationship between peripheral tissue characteristics and pain symptoms in soft tissue inflammation is poorly understood. The primary aim of this study was to determine immunohistochemical differences in tissue obtained from patients with persistent pain and patients who had become pain-free after surgical treatment for rotator cuff tendinopathy. The secondary aim was to investigate whether there would be differences in glutaminergic and inflammatory gene expression between disease-derived and healthy control cells in vitro. Methods: Supraspinatus tendon biopsies were obtained from nine patients with tendon pain before shoulder surgery and from nine further patients whose pain had resolved completely following shoulder surgery. Histological markers relating to the basic tendon characteristics, inflammation and glutaminergic signalling were quantified by immunohistochemical analysis. Gene expression of glutaminergic and inflammatory markers was determined in tenocyte explants derived from painful rotator cuff tendon tears in a separate cohort of patients and compared to that of explants from healthy control tendons. Dual labelling was performed to identify cell types expressing nociceptive neuromodulators. Results: Tendon samples from patients with persistent pain demonstrated increased levels of metabotropic glutamate receptor 2 (mGluR2), kainate receptor 1 (KA1), protein gene product 9.5 (PGP9.5), CD206 (macrophage marker) and CD45 (pan-leucocyte marker) versus pain-free controls (p <0.05). NMDAR1 co-localised with CD206-positive cells, whereas PGP9.5 and glutamate were predominantly expressed by resident tendon cells. These results were validated by in vitro increases in the expression of mGluR2, N-methyl-D-aspartate receptor (NMDAR1), KA1, CD45, CD206 and tumour necrosis factor alpha (TNF-aα) genes (p <0.05) in disease-derived versus control cells. Conclusions: We conclude that differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of shoulder pain in rotator cuff tendinopathy, and that disease-derived cells exhibit a distinctly different neuro-inflammatory gene expression profile to healthy control cells.","author":[{"dropping-particle":"","family":"Dean","given":"Benjamin John Floyd","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Snelling","given":"Sarah J.B.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dakin","given":"Stephanie G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphy","given":"Richard J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Javaid","given":"Muhammad Kassim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Carr","given":"Andrew Jonathan","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Arthritis Research and Therapy","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2015"]]},"page":"1-10","publisher":"Arthritis Research & Therapy","title":"Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"(Dean et al., 2015)","plainTextFormattedCitation":"(Dean et al., 2015)","previouslyFormattedCitation":"[7]"},"properties":{"noteIndex":0},"schema":""}(Dean et al., 2015). These factors can control cellular processes such as chemotaxis, angiogenesis, cell proliferation, mitogenesis, differentiation and metabolism within injured tissue with maximum resistance and limited adhesion of tissue ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4142/jvs.2010.11.2.173","ISSN":"1229845X","abstract":"This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations.","author":[{"dropping-particle":"","family":"Georg","given":"Rindermann","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maria","given":"Cislakova","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gisela","given":"Arndt","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bianca","given":"Carstanjen","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Veterinary Science","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2010"]]},"page":"173-175","title":"Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses","type":"article-journal","volume":"11"},"uris":[""]}],"mendeley":{"formattedCitation":"(Georg et al., 2010)","plainTextFormattedCitation":"(Georg et al., 2010)","previouslyFormattedCitation":"[13]"},"properties":{"noteIndex":0},"schema":""}(Georg et al., 2010;ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/s12917-016-0826-1","ISBN":"1291701608261","ISSN":"17466148","abstract":"Background: Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n=10) or control group (n=10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry. Results: Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively. Conclusions: A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.","author":[{"dropping-particle":"","family":"Geburek","given":"Florian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gaus","given":"Moritz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schie","given":"Hans T.M.","non-dropping-particle":"van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rohn","given":"Karl","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Stadler","given":"Peter M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"BMC Veterinary Research","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2016"]]},"page":"1-16","publisher":"BMC Veterinary Research","title":"Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies - a randomized prospective controlled clinical trial","type":"article-journal","volume":"12"},"uris":[""]}],"mendeley":{"formattedCitation":"(Geburek et al., 2016)","plainTextFormattedCitation":"(Geburek et al., 2016)","previouslyFormattedCitation":"[12]"},"properties":{"noteIndex":0},"schema":""} Geburek et al., 2016; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.17221/6761-VETMED","ISSN":"03758427","abstract":"The main goal of this study was to evaluate the effectiveness of a modified method for preparing platelet rich plasma for the treatment of superficial digital flexor tendon lesions in race horses and its influence on the future recuperation of the animals. The applied concentrate of plasma was prepared by centrifugation followed by aspiration close above the buffy coat. There were no negative reactions resulting from the application of the biological material into the damaged tendons. The success of the therapy was proven by the shortened rehabilitation time and the higher number of horses returning to racing.","author":[{"dropping-particle":"","family":"Zuffova","given":"Kristina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Krisova","given":"S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zert","given":"Z.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Veterinarni Medicina","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2013"]]},"page":"230-239","title":"Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing Thoroughbreds","type":"article-journal","volume":"58"},"uris":[""]}],"mendeley":{"formattedCitation":"(Zuffova et al., 2013)","plainTextFormattedCitation":"(Zuffova et al., 2013)","previouslyFormattedCitation":"[38]"},"properties":{"noteIndex":0},"schema":""}Zuffova et al., 2013). Treatments using PRP have been thoroughly studied in human medicine and experimental animal models to promote bone, tendon and ligament healing processes as well as intra-articular osteoarthritis care ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/ar3914 LK - ","ISSN":"1478-6354","abstract":"Chronic complex musculoskeletal injuries that are slow to heal pose challenges to physicians and researchers alike. Orthobiologics is a relatively newer science that involves application of naturally found materials from biological sources (for example, cell-based therapies), and offers exciting new possibilities to promote and accelerate bone and soft tissue healing. Platelet-rich plasma (PRP) is an orthobiologic that has recently gained popularity as an adjuvant treatment for musculoskeletal injuries. It is a volume of fractionated plasma from the patient's own blood that contains platelet concentrate. The platelets contain alpha granules that are rich in several growth factors, such as platelet-derived growth factor, transforming growth factor-beta, insulin-like growth factor, vascular endothelial growth factor and epidermal growth factor, which play key roles in tissue repair mechanisms. PRP has found application in diverse surgical fields to enhance bone and soft-tissue healing by placing supra-physiological concentrations of autologous platelets at the site of tissue damage. The relative ease of preparation, applicability in the clinical setting, favorable safety profile and possible beneficial outcome make PRP a promising therapeutic approach for future regenerative treatments. However, there is a large knowledge gap in our understanding of PRPs mechanism of action, which has raised skepticism regarding its potential efficacy and use. Thus, the aim of this review is to describe the various factors proposed to contribute to the biological activity of PRP, and the published pre-clinical and clinical evidence to support it. Additionally, we describe the current techniques and technology for PRP preparation, and review the present shortcomings of this therapy that will need to be overcome if it is to gain broad acceptance. 2012 BioMed Central Ltd.","author":[{"dropping-particle":"","family":"R.S.","given":"Dhillon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"E.M.","given":"Schwarz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"M.D.","given":"Maloney","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Arthritis Research and Therapy","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2012"]]},"page":"1-10","title":"Platelet-rich plasma therapy - future or trend?","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"(R.S. et al., 2012)","plainTextFormattedCitation":"(R.S. et al., 2012)","previouslyFormattedCitation":"[28]"},"properties":{"noteIndex":0},"schema":""}( Dhillon et al., 2012). Similarly, PRP was widely used in veterinary medicine to treat joint inflammation, tendon injuries and lower limb wounds ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/s12917-015-0403-z","ISSN":"17466148","PMID":"25896610","abstract":"Background: This systematic review aimed to present and critically appraise the available information on the efficacy of platelet rich plasma (PRP) in equine and human orthopedic therapeutics and to verify the influence of study design and methodology on the assumption of PRP's efficacy. We searched Medline, PubMed, Embase, Bireme and Google Scholar without restrictions until July 2013. Randomized trials, human cohort clinical studies or case series with a control group on the use of PRP in tendons, ligaments or articular lesions were included. Equine clinical studies on the same topics were included independently of their design. Experimental studies relevant to the clarification of PRP's effects and mechanisms of action in tissues of interest, conducted in any animal species, were selected. Results: This review included 123 studies. PRP's beneficial effects were observed in 46.7% of the clinical studies, while the absence of positive effects was observed in 43.3%. Among experimental studies, 73% yielded positive results, and 7.9% yielded negative results. The most frequent flaws in the clinical trials' designs were the lack of a true placebo group, poor product characterization, insufficient blinding, small sampling, short follow-up periods, and adoption of poor outcome measures. The methods employed for PRP preparation and administration and the selected outcome measures varied greatly. Poor study design was a common feature of equine clinical trials. From studies in which PRP had beneficial effects, 67.8% had an overall high risk of bias. From the studies in which PRP failed to exhibit beneficial effects, 67.8% had an overall low risk of bias. Conclusions: Most experimental studies revealed positive effects of PRP. Although the majority of equine clinical studies yielded positive results, the human clinical trials' results failed to corroborate these findings. In both species, beneficial results were more frequently observed in studies with a high risk of bias. The use of PRP in musculoskeletal lesions, although safe and promising, has still not shown strong evidence in clinical scenarios.","author":[{"dropping-particle":"","family":"Brossi","given":"Patrícia M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moreira","given":"Juliana J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Machado","given":"Thaís S.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baccarin","given":"Raquel Y.A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"BMC Veterinary Research","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2015"]]},"page":"1-17","publisher":"???","title":"Platelet-rich plasma in orthopedic therapy: A comparative systematic review of clinical and experimental data in equine and human musculoskeletal lesions","type":"article-journal","volume":"11"},"uris":[""]}],"mendeley":{"formattedCitation":"(Brossi et al., 2015)","plainTextFormattedCitation":"(Brossi et al., 2015)","previouslyFormattedCitation":"[4]"},"properties":{"noteIndex":0},"schema":""}( Greci et al., 2009; Brossi et al., 2015). Therefore, the purpose of this study was to clinically evaluate the outcomes of of external rectus sheath turnover flap as an autologous graft alone and as a novel autologous composite with autologous PRP for reconstruction of large scrotal hernia in ram. Materials and methods Ethics Statement and Animals The study procedures were performed in accordance with recommendations of the guidelines for care and use of animals at the College of Veterinary Medicine, Benha University. The research protocol was approved by the Ethical Committee for Institutional Animal Use and Care of the College of Veterinary Medicine, Benha University (BUFVTM 15-09-2018). A total of thirteen baladi rams, aged 18 to 36 months and weighting between 12 to 43 kg were selected and included in this study. All rams were admitted to the veterinary hospitals at college of Veterinary Medicine, Benha University during the period from December 2018 till may 2020. The rams were suffering from large unilateral voluminous scrotal swelling (Figure 1A). All rams were clinically examined to exclude other diseases and to evaluate hernia reducibility and hernia ring dimensions. Hernial ring sizes varied between 7 and 12 cm in width and 10-14 cm in length. Rams were divided randomly into two groups, group-A (n=6) underwent surgical correction with external rectus sheath turnover flap (ERF) of the same side and group-B (n=7) underwent surgical correction by ERF with PRP (ERF-PRP).Pre-operative preparation and anesthesiaBefore surgical intervention, all rams were fasted for 12 hours and water was withheld for 6 hours until surgery. The rams were premedicated using intramuscular injection of Xylazine hydrochloride (Xylaject ?, ADWIA, EL Sharkeya governorate, Egypt) as a pre-anesthetic sedative with a dose rate of 0.2 mg / Kg body weight. Rams were then restrained in dorsal recumbency and the surgical field was prepared aseptically and draped with sterile towels. Finally, 2% of Lignocaine hydrochloride (Depocain ?, Arabco, Cairo,?Egypt) was infiltrated locally at the skin incision site.PRP preparation, quantification, and activationPRP was prepared and activated according to ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joms.2004.06.047","ISSN":"02782391","abstract":"In this study, our aim was to prepare low-cost autogenous platelet-rich plasma (PRP) for use in minor bone grafting procedures. This was the preliminary study of an experimental study concerning augmentation of bony defects with a mixture of PRP and β-tricalcium phosphate. Venous blood was collected from marginal ear veins of New Zealand White rabbits in EDTA (K3) vacutainer tubes. Blood samples were divided into 2 groups, and PRP was prepared through 2 methods, 1 of which is a variant of the other. The 2 PRP preparation methods described in this study were modified from Landesberg et al (J Oral Maxillofac Surg 58:297, 2000) after several trials, because the platelet enrichment percentages we obtained using their method were very low. Complete blood counts of venous blood samples, PRP, and platelet poor plasma (PPP) were made. Statistical analyses were performed using SPSS for Windows (SPSS, Chicago, IL). It took approximately 30 minutes to prepare PRP with both methods. Platelet counts in PRP were increased with respect to venous blood platelet counts. The differences between the experimental groups and genders were evaluated statistically with Mann-Whitney U tests (P < .05). Correlations between the groups and genders were also evaluated (P < .05). It was experimentally shown that PRP with high platelet counts can be prepared using this modified method without the need for costly autotransfusion systems. ? 2004 American Association of Oral and Maxillofacial Surgeons.","author":[{"dropping-particle":"","family":"Efeoglu","given":"Candan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ak?ay","given":"Yasemin Delen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ertürk","given":"Selda","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Oral and Maxillofacial Surgery","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2004"]]},"page":"1403-1407","title":"A modified method for preparing platelet-rich plasma: An experimental study","type":"article-journal","volume":"62"},"uris":[""]}],"mendeley":{"formattedCitation":"(Efeoglu et al., 2004)","plainTextFormattedCitation":"(Efeoglu et al., 2004)","previouslyFormattedCitation":"[9]"},"properties":{"noteIndex":0},"schema":""}(Efeoglu et al., 2004). Briefly, baseline platelet counts were collected from all blood samples prior to processing and after PRP preparation. Platelet count was performed using hematology analyzer (Esco Micro Pte. Ltd., Changi, Singapore). The mean number of peripheral blood platelets count was 146.16±15.7×10? platelets/ml and the mean number of PRP platelets count was 431±32.1×10? platelets/ml. The mean number of platelets in PRP was 3.5 ± 0.4-fold greater than that of whole blood.Operative techniquesAutologous grafting was accomplished in the ERF group through a prescrotal skin incision (10-15 cm) carried out over the hernial ring and extended along paramedin line (Figure 1B). The status of hernial sac and hernial ring was examined after skin and subcutaneous dissection of the tissue to confirm the presence or absence of adhesions of hernial contents, testicles, and hernial sac. The spermatic cord was ligated by double transfixation ligatures and transected in-between for castration. Skin and subcutaneous layers were dissected anteriorly from the underlying external rectus sheath. U-shaped sheath flap was incised medially, anteriorly and posteriorly, and dissected from undelaying with flap dimensions varying depending on the dimensions of the defect (the flap was incised 2 cm larger than the ring) (Figure 1C). The flap was gently grasped posteriorly to repair the defect by on-lay technique using interrupted horizontal mattress suture pattern using XLG, No. 2 (Vicryl, Ethicon Ltd. U.K) (Figure 1D). In the ERF-PRP group, autologous grafting was accomplished using same procedures in the ERF group. Before suture fixation, activated PRP was added to the surface of incised U-shaped sheath flap for approximately 10 minutes, followed by application of the remainder of PRP to the surface of flap after suture fixation and prior to incisional closure (Figure 1E). Finally, chromic cat gut, No. 0 (Ethicon Ltd. U.K) was used to close the subcutaneous tissue including the base of scrotum, and then the skin was closed by disrupted horizontal mattress using silk No. 2 (Ethicon Ltd. U.K).Post-operative managementPost-operatively, all rams were kept in warm, clean well-bedded area (each after its procedure according to the time of case admission). Postoperative treatment lasted for 5 consecutive days, including daily wound dressing using 10% povidon iodine (Betadine ?, Nile Co., Cairo Egypt); and antibiotic spray of bavitracin twice daily (Neomycin, Bacitracin Aerosol powder Spray 150 ml, ACDIMA International, Giza, Egypt). Broad spectrum antibiotic, 4ml/100 kg pentomycin (procaine benzylpenicillin and 200mg / ml dihydrostreptomycin, Univet Vet Pharmaceutical company, Newtownards, UK) and anti-inflammatory 2mg / kg flunidine (flunixin meglumine ?, Arabco, Cairo, Egypt) were also injected intramuscularly. A prophylactic dose of anti-tetanus serum 1,500 IU was additionally injected subcutaneously. On the 12th post-surgical day, the skin stitches were removed. The feeding regimen began in low amounts of soft food, with a third in the first week, and gradually increased until regular feeding was resumed.Timeline, postoperative follow up and technique evaluation:The hernioplasty technique was evaluated by clinical inspection, hematological examination, and ultrasonography over a period of 6 weeks postoperative.1-Clinical evaluation: All rams were evaluated clinically to determine any complications, pain, and heat at surgical site using a modified grading scale system (as shown in Table 1).2-Haematological examination: Two blood samples were collected by jugular vein puncture for both hematological and biochemical analyzes. The first blood sample was taken with anticoagulant (EDTA) for determination of total erythrocytes count (RBCs), hemoglobin (HB), packed cell volume (PCV), MCV, MCH, MCHC, WBCs, neutrophil, lymphocytes, monocytes, eosinophils, and basophils using hematology analyzer (Model XF9080, Perlong Medical Machine Co. Ltd, Nanjing, Chin). The second blood sample was centrifuged at 3,000 rpm for 10 minutes, and clear, non-hemolyzed serum samples were stored at ?20°C until further testing. Acute phase proteins (SAA and Hp) and inflammatory cytokines (TNF-α and IL-1β) were assessed using commercially available ELISA Kits (CUSABIO Biotech Co. Ltd, Wuhan, China). 3-Ultrasonography evaluation: All rams were restrained in dorsal recumbent position and the site of operation was shaved and aseptically prepared. Ultrasonography assessment was conducted using a transcutaneous approach using a portable ultrasound machine (Chison ECO3 Expert, Medical EXPO, Shanghai, China) with an adjusted 8.5 MHz linear transducer ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2754/avb200978040657","ISSN":"00017213","abstract":"A four-year-old ram was presented with a conspicuous hemilateral scrotal enlargement that was noticed four weeks before. Based on the history, clinical signs, palpation, trans-scrotal ultrasonography and semen collection, a left scrotal hernia was diagnosed. Ultrasonographic examination showed a presumably omental fat scrotal hernia with an atrophic left testis and varicocele, and the presence of two sperm cysts could be observed in the right epididymal tail. The testis appeared as a homogeneous and moderately echogenic structure and it was possible to distinguish atrophy of the left testis that was covered by a hyperechoic area, presumably omental fat, within the hernial sac. In addition, on ultrasound examination non-echogenic tortuous areas were present and diagnosed as varicocele. Post mortem examination confirmed gross lesions identified ultrasonographically. The libido of the ram was normal but the semen showed total azoospermia. Ultrasound imaging can be used as a diagnostic technique to confirm the diagnosis of scrotal hernia, varicocele, sperm cyst and testis mineralization.","author":[{"dropping-particle":"","family":"Lacasta","given":"Delia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferrer","given":"Luís M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ramos","given":"Juan J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ochoa","given":"Pablo Gómez","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta Veterinaria Brno","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2009"]]},"page":"657-659","title":"Ultrasonographic diagnosis of unilateral scrotal hernia, varicocele and sperm granuloma in a ram","type":"article-journal","volume":"78"},"uris":[""]}],"mendeley":{"formattedCitation":"(Lacasta et al., 2009)","plainTextFormattedCitation":"(Lacasta et al., 2009)","previouslyFormattedCitation":"[19]"},"properties":{"noteIndex":0},"schema":""}(Lacasta et al., 2009). All ultrasonography evaluations were conducted at a depth of 4 cm. Ultrasonographically, quantitative measurement of subcutaneous edema and visceral adhesion was accomplished and graded according to a modified numerical scale system (Table 1). Colored flow Doppler ultrasonography was used for subjective analysis of the grafting site's vascularity using 2-4 MHz Convex transducer attached to the ultrasonography machine (SonoScape E2 color Doppler, Shenzhen, China). Statistical analysisStatistical analysis was performed using JMP? Pro 13 (SAS Institute Inc. Cary, NC, USA). Normality of the data distribution was evaluated by the Shapiro-Wilk test. Comparisons between groups at different time points were performed using a mixed-model ANOVA with the animal as a random effect and time-point as a repeated effect. Significance was set at (p<0.05) and all values were presented as the mean ± standard error (SE). Results Clinical evaluationAll surgical procedures were easily performed and well tolerated by all rams from both groups. The scrotal hernia was successfully reduced, and graft turnover procedure was easily carried out in all rams. In all cases, the graft did not lose its integrity and there was no any inflammation or abscesses. Clinical examination revealed significant difference in pain, heat and complication scores between both groups (Table 2). Pain assessment in the ERF group showed moderate pain, with score 0.33±0.52 at day 35. While the ERF-PRP group depicted the lowest score of pain at all time points with score 0 at day 28 (Table 2). Similarly, heat evaluation in the ERF group showed moderate heat, with score 0.33±0.52 at day 35. While the ERF-PRP group depicted the mild heat with score 0 at day 28 (Table 2). No post-operative complications were observed in all rams in ERF-PRP group and the abdominal wall regained its normal integrity without any noticed abnormalities. While in the ERF group, assessment of postoperative complication showed marked persistent of postoperative edema with a subsequent stitch dehiscence, sepsis formation and closure failure in one ram. Hematological examinationAt day 0 before surgical intervention, no significant differences (P>0.05) were noted in any blood hematological and biochemical parameters among the ERF and ERF-PRP groups (Table 3). Assessment of hematological parameter showed that RBCs count, Hb content and PCV%, MCV, MCH, MCHC were non significantly (P>0.05) decreased at day 1 post-operative compared to day 0 (Table 3). Surgical application of ERF and ERF-PRP did not have a significant effect on?RBCs count, Hb content and PCV%, MCV, MCH, MCHC count (Table 3).WBCs, neutrophil, lymphocytes, monocytes, eosinophils, and basophils count were significantly increased (P≤0.05) at day 1 post-operative when compared to day 0 (Table 3). The ERF-PRP group revealed significant low WBCs, neutrophil, lymphocytes, eosinophils, and basophils count when compared to the ERF group at days 3, and 7 (Table 3).Assessment of APP and proinflammatory cytokines in both groups were significantly increased at day 1 post-operative compared to day 0. The ERF-PRP group revealed significant low SAA, Hp, TNF-α and IL-1β levels when compared to the ERF group at days 3, 7, 14, 21, and 28 (Table 3). Ultrasonographic examination and adhesion scoreUltrasonographic examination of all rams in the ERF and ERF-PRP groups showed that the graft was secured and correctly positioned. Postoperative ultrasonographic examination revealed that the rectus flap had a characteristic appearance of fine muscle fibers as an extension of thicker muscle of rectus abdominis accompanied by a slight attenuation of ultrasonic beam (Figure 2). Subcutaneous edema assessment in the ERF group showed mild to moderate edema, with score 0 at day 35. While the ERF-PRP group showed mild degree of edema with score 0 at day 21. Adhesion evaluation at day 35 showed mild to no adhesion in the ERF-PRP group and mild to moderate adhesion in the ERF group (Table 2). Ultrasound Color Doppler recorded higher vascularity in the form of a high-color signal at lateral margin of turned over flap in the ERF-PRP group at days 7, 21 and 35-days post-operative (Figure 3).Discussion Although no literature on the use of the external rectus sheath flap for the reconstruction of large abdominal wall defects, several techniques have been suggested in human surgery ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2106/JBJS.J.01513","ISSN":"15351386","abstract":"? Autogenous cancellous bone graft provides an osteoconductive, osteoinductive, and osteogenic substrate for filling bone voids and augmenting fracture-healing. ? The iliac crest remains the most frequently used site for bone-graft harvest, but the proximal part of the tibia, distal end of the radius, distal aspect of the tibia, and greater trochanter are alternative donor sites that are particularly useful for bone-grafting in the ipsilateral extremity. ? The most common complication associated with the harvest of autogenous bone graft is pain at the donor site, with less frequent complications including nerve injury, hematoma, infection, and fracture at the donor site. ? Induced membranes is a method that uses a temporary polymethylmethacrylate cement spacer to create a bone-graft-friendly environment to facilitate graft incorporation, even in large segmental defects. Copyright ? 2011 by the Journal of Bone and Joint Surgery Incorporated.","author":[{"dropping-particle":"","family":"Myeroff","given":"Chad","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Archdeacon","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Bone and Joint Surgery - Series A","id":"ITEM-1","issue":"23","issued":{"date-parts":[["2011"]]},"page":"2227-2236","title":"Autogenous bone graft: Donor sites and techniques","type":"article-journal","volume":"93"},"uris":[""]}],"mendeley":{"formattedCitation":"(Myeroff and Archdeacon, 2011)","plainTextFormattedCitation":"(Myeroff and Archdeacon, 2011)","previouslyFormattedCitation":"[24]"},"properties":{"noteIndex":0},"schema":""}(Myeroff and Archdeacon, 2011; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00268-006-0282-3","ISSN":"03642313","abstract":"Background: Many patients requiring conventional open abdominal management need a postoperative intermediate period with a large ventral hernia. This situation, in which the granulated abdominal contents are covered only with a skin graft, carry with it a high risk of enterocutaneous fistula, and the patients ultimately require late-stage abdominal wall reconstruction. Early abdominal wall reconstruction in noncandidates for standard fascial closure has received little attention. In this study we used bilateral anterior rectus abdominis sheath turnover flaps for early fascial closure which, to date, has not been evaluated as a technique for early fascial closure. Methods: Eleven trauma and 18 nontrauma cases requiring open abdominal management over a 7-year period were reviewed. Bilateral anterior rectus abdominis sheath turnover flaps were created by longitudinal incisions along the lateral edge of the anterior rectus sheath, which were mobilized medially and approximated. The skin was closed primarily. Results: Twelve nontrauma and eight trauma patients survived. No enteric fistula or abdominal abscess occurred. Anterior rectus sheath turnover flaps were used in nine of the 18 nontrauma and two of the 11 trauma patients, all of whom were unsuitable for standard fascial closure of prolonged visceral edema; the respective mean intervals from initial laparotomy to fascial closure were 9.4 and 18 days. Of the 11 patients with flaps, ten survived without fascial dehiscence or herniation (maximum follow-up: 65 months). Conclusions: Early fascial closure using the anterior rectus abdominis sheath turnover flap may reduce the need for skin grafting and subsequent abdominal wall reconstruction. This approach can be considered as an alternative technique in the early management of patients with open abdomen. ? 2006 Société Internationale de Chirurgie.","author":[{"dropping-particle":"","family":"Kushimoto","given":"Shigeki","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamamoto","given":"Yasuhiro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aiboshi","given":"Junichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ogawa","given":"Futoshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koido","given":"Yuichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yoshida","given":"Ryusuke","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kawai","given":"Makato","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"World Journal of Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2007"]]},"page":"2-8","title":"Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management","type":"article-journal","volume":"31"},"uris":[""]}],"mendeley":{"formattedCitation":"(Kushimoto et al., 2007)","plainTextFormattedCitation":"(Kushimoto et al., 2007)","previouslyFormattedCitation":"[18]"},"properties":{"noteIndex":0},"schema":""}Kushimoto et al., 2007). After grafting, tissue responses have been enhanced using PRP as a source of growth factor and chemokine ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s12178-008-9032-5","ISSN":"1935-9748","abstract":"In Europe and the United States, there is an increasing prevalence of the use of autologous blood products to facilitate healing in a variety of applications. Recently, we have learned more about specific growth factors, which play a crucial role in the healing process. With that knowledge there is abundant enthusiasm in the application of concentrated platelets, which release a supra-maximal quantity of these growth factors to stimulate recovery in non-healing injuries. For 20 years, the application of autologous PRP has been safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic, and maxillofacial surgery. This article introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality. In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing. However, there are few controlled trials, and mostly anecdotal or case reports. Additionally the sample sizes are frequently small, limiting the generalization of the findings. Recently, there is emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries including lateral epicondylitis and plantar fasciitis and cartilage degeneration (Mishra and Pavelko, The American Journal of Sports Medicine 10(10):1-5, 2006; Barrett and Erredge, Podiatry Today 17:37-42, 2004). However, as clinical use increases, more controlled studies are needed to further understand this treatment.","author":[{"dropping-particle":"","family":"Sampson","given":"Steven","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gerhardt","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mandelbaum","given":"Bert","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Current Reviews in Musculoskeletal Medicine","id":"ITEM-1","issue":"3-4","issued":{"date-parts":[["2008"]]},"page":"165-174","title":"Platelet rich plasma injection grafts for musculoskeletal injuries: a review","type":"article-journal","volume":"1"},"uris":[""]}],"mendeley":{"formattedCitation":"(Sampson et al., 2008)","plainTextFormattedCitation":"(Sampson et al., 2008)","previouslyFormattedCitation":"[31]"},"properties":{"noteIndex":0},"schema":""}(Sampson et al., 2008; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s40141-013-0039-5","ISSN":"2167-4833","abstract":"Injection of platelet-rich plasma (PRP) is an evolving treatment option for various musculoskeletal injuries. There is basic scientific evidence that suggests that the various growth factors present in PRP can help to augment the body’s natural healing. There are also clinical studies suggesting efficacy for several conditions, particularly tendinopathy and osteoarthritis. This article reviews the definition and first uses of PRP, the basic scientific rationale for its use, and the basic science and evidence for its use in the treatment of tendon, joint, ligament, and muscle injuries. There are varying levels of evidence for and against the use of PRP for these types of injuries, and this article reviews studies that support as well as studies that refute the use of this new treatment. There are several studies that have assessed the basic science supportive of PRP treatments, as well as the clinical efficacy of this treatment in vivo. While the current evidence is mixed, several recent studies have demonstrated therapeutic benefit in the treatment of various tendinopathies and degenerative joint diseases of the knee. There are several factors that need to be addressed to elucidate whether PRP is truly effective. These include fully defining the PRP mixture (e.g. concentration, growth factor levels, presence of white cells and red cells, etc.), determining the optimal preparation and delivery of the PRP graft, calculating the appropriate number of injections for each specific pathologic process, and defining optimal post-procedure rehabilitation.","author":[{"dropping-particle":"","family":"Malanga","given":"Gerard A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goldin","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Current Physical Medicine and Rehabilitation Reports","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2014"]]},"page":"1-15","title":"PRP: review of the current evidence for musculoskeletal conditions","type":"article-journal","volume":"2"},"uris":[""]}],"mendeley":{"formattedCitation":"(Malanga and Goldin, 2014)","plainTextFormattedCitation":"(Malanga and Goldin, 2014)","previouslyFormattedCitation":"[22]"},"properties":{"noteIndex":0},"schema":""}Malanga and Goldin, 2014). Therefore, the present study was planned to determine the effectiveness of external rectus sheath turnover flap as an autologous graft alone and as a novel autologous composite with autologous PRP for reconstruction of large scrotal hernia in ram. Our results showed that the use of an autologous composite of external rectus sheath turnover flap with PRP to correct abdominal wall defects is correlated with improved clinical outcomes, increased closure strength, and subsequent decreased occurrence of reherniation and other related complications. Similarly, the use of ERF for the reconstruction of large abdominal wall defect was previously explored ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4103/1110-1121.167390","ISSN":"1110-1121","author":[{"dropping-particle":"","family":"Samir","given":"Mohamed","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hany","given":"Mohamed","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ibrahim","given":"Mohamed","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Egyptian Journal of Surgery","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2015"]]},"page":"272","title":"Evaluation of component separation technique in the repair of complex large ventral hernia with large defects","type":"article-journal","volume":"34"},"uris":[""]}],"mendeley":{"formattedCitation":"(Samir et al., 2015)","plainTextFormattedCitation":"(Samir et al., 2015)","previouslyFormattedCitation":"[30]"},"properties":{"noteIndex":0},"schema":""}(Samir et al., 2015). Additionally, no abdominal wall hernia requiring secondary repair without any prosthetic material strengthening the flap was reported ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1002/lt","ISSN":"15276465","PMID":"17563933","author":[{"dropping-particle":"","family":"Takahashi Masahiro; Seigo Nishida, Zubin Panthaki, Antonio Romano, Akin Tekin, Eddie R. Island, Jang I. Moon","given":"David M. Levi","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Liver Transplantation","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007"]]},"page":"767-768","title":"Use of the Bilateral Anterior Rectus Fascia Turnover Method and the Components Separation Method for a Difficult Abdominal Closure After Transplantation","type":"article-journal","volume":"13"},"uris":[""]}],"mendeley":{"formattedCitation":"(Takahashi Masahiro; Seigo Nishida, Zubin Panthaki, Antonio Romano, Akin Tekin, Eddie R. Island, Jang I. Moon, 2007)","plainTextFormattedCitation":"(Takahashi Masahiro; Seigo Nishida, Zubin Panthaki, Antonio Romano, Akin Tekin, Eddie R. Island, Jang I. Moon, 2007)","previouslyFormattedCitation":"[34]"},"properties":{"noteIndex":0},"schema":""}(Takahashi et al., 2007). Evaluation of pain and local heat scores revealed that the rams of the ERF-PRP group experienced only a moderate post-operative pain and heat with a significant difference when compared to ERF group (P<0.01). This might be due to the inflammatory response-managing impact of PRP, that was identified by the significant increase in serum acute phase proteins (Hp and SAA) and inflammatory cytokines (IL-1β and TNFα) in ERF-PRP group. Several research articles have similarly studied the PRP's anti-inflammatory properties ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.17221/7478-VETMED","ISSN":"03758427","abstract":"The acute phase response is a complex systemic early-defence system of reactions activated by trauma, infection, tissue damage, inflammation, stress or neoplasia. One of the most important elements of this response is the increased hepatic synthesis of some plasma proteins, collectively known as acute phase proteins. The discovery of these new biomarkers has allowed the clinical monitoring of different diseases; therefore, their clinical application has been studied widely in human medicine in order to improve the diagnosis, evaluation, treatment, prognosis and therapeutics of many diseases. Although a wide range of studies have been carried out to determine the usefulness of acute phase proteins in several diseases also in animals, they are still relatively under-utilised in veterinary medicine, predominantly in farm animals. The acute phase response and clinical application of acute phase proteins in ruminants are reviewed in this article, including their diagnostic use in clinical practice and application in the monitoring of treatment, which is one of the most promising practical uses of these proteins.","author":[{"dropping-particle":"","family":"Tothova","given":"Csilla","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nagy","given":"O.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kovac","given":"G.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Veterinarni Medicina","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2014"]]},"page":"163-180","title":"Acute phase proteins and their use in the diagnosis of diseases in ruminants: A review","type":"article-journal","volume":"59"},"uris":[""]}],"mendeley":{"formattedCitation":"(Tothova et al., 2014)","plainTextFormattedCitation":"(Tothova et al., 2014)","previouslyFormattedCitation":"[35]"},"properties":{"noteIndex":0},"schema":""}(Tothova et al., 2014). PRP can suppress the release of cytokine, promote the release of RANTES, a major monocyte chemoattractant, from its alpha-granules, limit inflammation, encourage tissue regeneration and depress the inflammatory cells specially lymphocytes ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3109/00016357.2015.1035672","author":[{"dropping-particle":"","family":"Agarwal","given":"Ashish","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gupta","given":"Narinder Dev","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jain","given":"Avikal","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta Odontologica Scandinavica","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2016"]]},"note":"PMID: 25972081","page":"36-43","publisher":"Taylor & Francis","title":"Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail","type":"article-journal","volume":"74"},"uris":[""]}],"mendeley":{"formattedCitation":"(Agarwal et al., 2016)","plainTextFormattedCitation":"(Agarwal et al., 2016)","previouslyFormattedCitation":"[1]"},"properties":{"noteIndex":0},"schema":""}(El-Sharkawy et al., 2007; Agarwal et al., 2016). Additionally, the corresponding functions of PRP correlates with substantial postoperative reductions in circulating lymphocyte in this study. Although one ram in the ERF group revealed marked persistent postoperative edema with a subsequent skin stitch dehiscence, and sepsis formation, the ERF-PRP group exhibited complete recovery without any complications. Recent studies have shown that platelets play a direct role in the detection, sequesteration, and neutralization of invasive pathogens and have indirect role in recruitment of leukocytes to inflammatory sites and killing of microorganisms by activating different signals pathways ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3109/09537104.2015.1010441","author":[{"dropping-particle":"","family":"Jenne","given":"Craig N","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kubes","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Platelets","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2015"]]},"page":"286-292","publisher":"Taylor & Francis","title":"Platelets in inflammation and infection","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"(Jenne and Kubes, 2015)","plainTextFormattedCitation":"(Jenne and Kubes, 2015)","previouslyFormattedCitation":"[17]"},"properties":{"noteIndex":0},"schema":""}( Choukroun et al., 2006; Jenne and Kubes, 2015). This theory is confirmed in our study by a substantial postoperative high WBCS during the first three days in the ERF-PRP group.Postoperative clinical follow up revealed no evidence of hernial recurrence in the ERF-PRP group and reherniation in one ram from the ERF group. The beneficial regenerative healing effects of PRP are due to the release of several growth factors component from the degranulated activated platelets including; PDGF, TGF, IGF, FGF, HGF and VEGF ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1186/s13075-015-0691-5","ISSN":"14786362","abstract":"Introduction: The relationship between peripheral tissue characteristics and pain symptoms in soft tissue inflammation is poorly understood. The primary aim of this study was to determine immunohistochemical differences in tissue obtained from patients with persistent pain and patients who had become pain-free after surgical treatment for rotator cuff tendinopathy. The secondary aim was to investigate whether there would be differences in glutaminergic and inflammatory gene expression between disease-derived and healthy control cells in vitro. Methods: Supraspinatus tendon biopsies were obtained from nine patients with tendon pain before shoulder surgery and from nine further patients whose pain had resolved completely following shoulder surgery. Histological markers relating to the basic tendon characteristics, inflammation and glutaminergic signalling were quantified by immunohistochemical analysis. Gene expression of glutaminergic and inflammatory markers was determined in tenocyte explants derived from painful rotator cuff tendon tears in a separate cohort of patients and compared to that of explants from healthy control tendons. Dual labelling was performed to identify cell types expressing nociceptive neuromodulators. Results: Tendon samples from patients with persistent pain demonstrated increased levels of metabotropic glutamate receptor 2 (mGluR2), kainate receptor 1 (KA1), protein gene product 9.5 (PGP9.5), CD206 (macrophage marker) and CD45 (pan-leucocyte marker) versus pain-free controls (p <0.05). NMDAR1 co-localised with CD206-positive cells, whereas PGP9.5 and glutamate were predominantly expressed by resident tendon cells. These results were validated by in vitro increases in the expression of mGluR2, N-methyl-D-aspartate receptor (NMDAR1), KA1, CD45, CD206 and tumour necrosis factor alpha (TNF-aα) genes (p <0.05) in disease-derived versus control cells. Conclusions: We conclude that differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of shoulder pain in rotator cuff tendinopathy, and that disease-derived cells exhibit a distinctly different neuro-inflammatory gene expression profile to healthy control cells.","author":[{"dropping-particle":"","family":"Dean","given":"Benjamin John Floyd","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Snelling","given":"Sarah J.B.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dakin","given":"Stephanie G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphy","given":"Richard J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Javaid","given":"Muhammad Kassim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Carr","given":"Andrew Jonathan","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Arthritis Research and Therapy","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2015"]]},"page":"1-10","publisher":"Arthritis Research & Therapy","title":"Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"(Dean et al., 2015)","plainTextFormattedCitation":"(Dean et al., 2015)","previouslyFormattedCitation":"[7]"},"properties":{"noteIndex":0},"schema":""}(Dean et al., 2015). Similarly, previous studies showed that the tensile strength of the graft-host scaffold is associated with single-dose PRP therapy involving the development of highly organized collagen and deposition of muscle fibers with predominant angiogenesis ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1089/ten.tea.2007.0316","ISSN":"1937335X","abstract":"Commercially available human acellular dermal matrix (HADM), AlloDerm?, was implanted as an interpositional graft in the abdominal wall of adult vervet monkeys. Host response to implanted HADM was evaluated and compared with a human cellular dermal matrix (HCDM) and a primate acellular dermal matrix (PADM). Clinical acceptance of the acellular grafts (HADM and PADM) and graft remodeling were evidenced by fibroblast repopulation and neoangiogenesis. A mild inflammatory response marked predominantly by macrophages and T-cells was present in both HADM and PADM during the first month but was absent by 3 months. Similarly, antibody and complement deposition into the grafts as well as in the serum was evident only at the early time points. Interleukin-6 (IL-6) or IL-10 was induced in some acellular graft-implanted monkeys at the early time points, but tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), or IL-2 was not detected over the study period. In contrast, significant inflammation was observed in HCDM-implanted animals, as evidenced by immune cell infiltration (p ≤ 0.0001), immunoglobulin G (IgG) binding (p < 0.001), complement (C5b) deposition (p < 0.05), TNF-α deposition (p < 0.001), and macrophage activation (p < 0.05). Abdominal wall repair in the vervet monkey is an immunologically relevant model to evaluate functional efficacy and host immune response to implanted biomaterials and may be predictive of clinical response and surgical outcomes in humans. ? Copyright 2008, Mary Ann Liebert, Inc.","author":[{"dropping-particle":"","family":"Xu","given":"Hui","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wan","given":"Hua","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sandor","given":"Maryellen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qi","given":"Shijie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ervin","given":"Frank","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Harper","given":"John R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Silverman","given":"Ronald P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McQuillan","given":"David J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Tissue Engineering - Part A","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2008"]]},"page":"2009-2019","title":"Host response to human acellular dermal matrix transplantation in a primate model of abdominal wall repair","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"(Xu et al., 2008)","plainTextFormattedCitation":"(Xu et al., 2008)","previouslyFormattedCitation":"[37]"},"properties":{"noteIndex":0},"schema":""}(Xu et al., 2008; ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00464-015-4645-4","ISSN":"14322218","abstract":"Background: Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia repair has reduced their use largely to bridging repair and breast reconstruction. Modalities that improve classic cellular metrics of successful VHR could theoretically result in improved rates of hernia recurrence; autologous platelet-rich plasma (PRP) may represent one such tool, but has been underinvestigated for this purpose. Methods: Lewis rats (32) had chronic ventral hernias created surgically and then repaired with Strattice? mesh alone (control) or mesh?+?autologous PRP. Samples were harvested at 3 and 6?months postoperatively and compared for gross, histologic, and molecular outcomes of: neovascularization, tissue incorporation, peritoneal adhesions, hernia recurrence, and residual mesh thickness. Results: Compared to control at 3?months postoperatively, PRP-treated rats displayed significantly more neovascularization of implanted mesh and considerable upregulation of both angiogenic genes (vEGF 2.73-fold, vWF 2.21-fold) and myofibroblastic genes (αSMA 9.68-fold, FSP-1 3.61-fold, Col1a1 3.32-fold, Col31a1 3.29-fold). Histologically, they also showed enhanced tissue deposition/ingrowth and diminished chronic immune cell infiltration. Peritoneal adhesions were less severe at both 3 (1.88 vs. 2.94) and 6?months (1.63 vs. 2.75) by Modified Hopkins Adhesion Scoring. PRP-treated rats experienced decreased hernia recurrence at 6?months (0/10 vs. 7/10) and had significantly improved ADM preservation as evidenced by quantification of residual mesh thickness. Conclusions: PRP is an autologous source of pro-regenerative growth factors and chemokines uniquely suited to soft tissue wound healing. When applied to a model of chronic VHR, it incites enhanced angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR.","author":[{"dropping-particle":"","family":"Eps","given":"Jeffrey","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fernandez-Moure","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cabrera","given":"Fernando","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Xin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Karim","given":"Azim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Corradetti","given":"Bruna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Paige","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dunkin","given":"Brian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tasciotti","given":"Ennio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weiner","given":"Bradley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ellsworth","given":"Warren","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Endoscopy","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2016"]]},"page":"3239-3249","publisher":"Springer US","title":"Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice? mesh in a rodent ventral hernia model","type":"article-journal","volume":"30"},"uris":[""]}],"mendeley":{"formattedCitation":"(Van Eps et al., 2016)","plainTextFormattedCitation":"(Van Eps et al., 2016)","previouslyFormattedCitation":"[11]"},"properties":{"noteIndex":0},"schema":""}Van Eps et al., 2016).In our study, ultrasonographic examination was used for diagnosis and follow-up the healing process following surgical correction of large scrotal hernia in rams. In line with other study, ultrasonographic assessment of graft-visceral and graft-subcutaneous adhesion was achieved, depending on the echogenic signal of the adhesion fibrous tissue ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.15557/jou.2013.0008","ISSN":"20848404","abstract":"Despite their frequent appearance, intra-abdominal adhesions are rarely the subject of clinical studies and academic discussions. For many years the operators have been trying to reduce such unfavourable consequences of interventions in the abdominal structures. The aim of this article is to present the possibilities of intra-abdominal adhesion diagnostics by means of ultrasound imaging based on authors' own experience and information included in pertinent literature. The anatomy and examination technique of the abdominal wall were discussed in Part I of the article. In order to evaluate intraperitoneal adhesions, one should use a convex transducer with the frequency of 3.5-6 MHz. The article provides numerous examples of US images presenting intra-abdominal adhesions, particularly those which appeared after surgical procedures. The significance of determining their localisation and extensiveness prior to a planned surgical treatment is emphasized. Four types of morphological changes in the ultrasound caused by intra-abdominal adhesions are distinguished and described: visceroperitoneal adhesions, intraperitoneal adhesions, adhesive obstructions as well as adhesions between the liver and abdominal wall with a special form of such changes, i.e. hepatic pseudotumour. Its ultrasound features are as follows:The lesion is localised below the scar in the abdominal wall after their incision.The lesion is localised in the abdominal part of the liver segments III, IV and V.With the US beam focus precisely set, the lack of fascia - peritoneum complex may be noticed. An uneven liver outline or its ventral displacement appears.A hepatic adhesion-related pseudotumour usually has indistinct margins, especially the posterior one, and, gradually, from top to bottom, loses its hypoechogenic nature.In a respiration test, this liver fragment does not present the sliding movement - a neoplastic tumour rarely shows such an effect. The immobility of the liver is a permanent symptom of subdiaphragmatic abscess which needs to be included in the differentiation process.In case of doubts, the suspicious liver area may be examined without the consideration of the scar in the abdominal wall. In the differentiation of visceroperitoneal adhesions, firstly, one needs to exclude the peritoneum infiltration in the course of inflammation and neoplastic spreading, which may be very difficult in patients who have undergone a surgery. Pseudomyxoma peritonei constitutes a source of errors m…","author":[{"dropping-particle":"","family":"Smereczyński","given":"Andrzej","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Starzyńska","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ko?aczyk","given":"Katarzyna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bojko","given":"Stefania","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ga?dyńska","given":"Maria","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bernatowicz","given":"El?bieta","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Walecka","given":"Anna","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Ultrasonography","id":"ITEM-1","issue":"52","issued":{"date-parts":[["2013"]]},"page":"93-103","title":"Intra-abdominal adhesions in ultrasound. Part II: The morphology of changes","type":"article-journal","volume":"13"},"uris":[""]}],"mendeley":{"formattedCitation":"(Smereczyński et al., 2013)","plainTextFormattedCitation":"(Smereczyński et al., 2013)","previouslyFormattedCitation":"[32]"},"properties":{"noteIndex":0},"schema":""}(Smereczyński et al., 2013). Qualitative scoring of adhesion manifested advantage of PRP in hernia correction. This result is important because a decrease in the formation of adhesion would minimize complications such as chronic intestinal pain obstruction and entero-cutaneous fistulae, which would require more surgical intervention ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0002-9610(00)00407-4","ISSN":"00029610","abstract":"BACKGROUND: Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure in hospitals around the world. The leading cause of SBO in the western world has become adhesions. The goal of this study was to determine the causes of SBO. METHODS: The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 552 patients accounting for 1,001 admissions. RESULTS: The etiology of SBO was adhesions (74%), Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Patients with Crohn's disease were younger than patients with other etiologies. Surprisingly, recurrence rates were similar for patients treated operatively as for those treated nonoperatively with the exception in the hernia group where higher recurrence rates were noted for patients initially treated in a nonoperative manner. CONCLUSION: The most common cause of SBO is adhesions followed by Crohn's disease and neoplasia. (C) 2000 by Excerpta Medica, Inc.","author":[{"dropping-particle":"","family":"Miller","given":"George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boman","given":"Jason","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shrier","given":"Ian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gordon","given":"Philip H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2000"]]},"page":"33-36","title":"Etiology of small bowel obstruction","type":"article-journal","volume":"180"},"uris":[""]}],"mendeley":{"formattedCitation":"(Miller et al., 2000)","plainTextFormattedCitation":"(Miller et al., 2000)","previouslyFormattedCitation":"[23]"},"properties":{"noteIndex":0},"schema":""}(Miller et al., 2000). In this study, the angiogenesis effect of PRP was confirmed by color doppler ultrasound, which reported higher vascularity in the form of a high-color signal at 7th, 21th, 42th days post-operative on the lateral margin of the turned over flap in the ERF-PRP group. Nevertheless, the exact role of PRP angiogenesis effect remains unclear. Likewise, ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00464-015-4645-4","ISSN":"14322218","abstract":"Background: Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia repair has reduced their use largely to bridging repair and breast reconstruction. Modalities that improve classic cellular metrics of successful VHR could theoretically result in improved rates of hernia recurrence; autologous platelet-rich plasma (PRP) may represent one such tool, but has been underinvestigated for this purpose. Methods: Lewis rats (32) had chronic ventral hernias created surgically and then repaired with Strattice? mesh alone (control) or mesh?+?autologous PRP. Samples were harvested at 3 and 6?months postoperatively and compared for gross, histologic, and molecular outcomes of: neovascularization, tissue incorporation, peritoneal adhesions, hernia recurrence, and residual mesh thickness. Results: Compared to control at 3?months postoperatively, PRP-treated rats displayed significantly more neovascularization of implanted mesh and considerable upregulation of both angiogenic genes (vEGF 2.73-fold, vWF 2.21-fold) and myofibroblastic genes (αSMA 9.68-fold, FSP-1 3.61-fold, Col1a1 3.32-fold, Col31a1 3.29-fold). Histologically, they also showed enhanced tissue deposition/ingrowth and diminished chronic immune cell infiltration. Peritoneal adhesions were less severe at both 3 (1.88 vs. 2.94) and 6?months (1.63 vs. 2.75) by Modified Hopkins Adhesion Scoring. PRP-treated rats experienced decreased hernia recurrence at 6?months (0/10 vs. 7/10) and had significantly improved ADM preservation as evidenced by quantification of residual mesh thickness. Conclusions: PRP is an autologous source of pro-regenerative growth factors and chemokines uniquely suited to soft tissue wound healing. When applied to a model of chronic VHR, it incites enhanced angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR.","author":[{"dropping-particle":"","family":"Eps","given":"Jeffrey","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fernandez-Moure","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cabrera","given":"Fernando","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Xin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Karim","given":"Azim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Corradetti","given":"Bruna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Paige","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dunkin","given":"Brian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tasciotti","given":"Ennio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weiner","given":"Bradley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ellsworth","given":"Warren","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Endoscopy","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2016"]]},"page":"3239-3249","publisher":"Springer US","title":"Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice? mesh in a rodent ventral hernia model","type":"article-journal","volume":"30"},"uris":[""]}],"mendeley":{"formattedCitation":"(Van Eps et al., 2016)","plainTextFormattedCitation":"(Van Eps et al., 2016)","previouslyFormattedCitation":"[11]"},"properties":{"noteIndex":0},"schema":""}(Van Eps et al., 2016) recorded that the PRPs treated patients showed very solid, large, interconnecting networks of more mature neovessels from overlapping tissue, but clearly penetrating deeper into the implanted mesh. This enhanced angiogenesis tended to be linearly related to increased deposition / ingrowth of tissue within the mesh relative to controls. On the other hand, the color doppler ultrasound showed early vascular signals in the ERF group, which attributed to the flap's postoperatively remained clarified blood supply at the base of its U type. It was proposed that the blood supply to the anterior rectal sheath derive mainly from the perforation of intramuscular branches of deep upper and lower epigastric arteries and dispersed within the flap in the form of a broad capillary network ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00268-006-0282-3","ISSN":"03642313","abstract":"Background: Many patients requiring conventional open abdominal management need a postoperative intermediate period with a large ventral hernia. This situation, in which the granulated abdominal contents are covered only with a skin graft, carry with it a high risk of enterocutaneous fistula, and the patients ultimately require late-stage abdominal wall reconstruction. Early abdominal wall reconstruction in noncandidates for standard fascial closure has received little attention. In this study we used bilateral anterior rectus abdominis sheath turnover flaps for early fascial closure which, to date, has not been evaluated as a technique for early fascial closure. Methods: Eleven trauma and 18 nontrauma cases requiring open abdominal management over a 7-year period were reviewed. Bilateral anterior rectus abdominis sheath turnover flaps were created by longitudinal incisions along the lateral edge of the anterior rectus sheath, which were mobilized medially and approximated. The skin was closed primarily. Results: Twelve nontrauma and eight trauma patients survived. No enteric fistula or abdominal abscess occurred. Anterior rectus sheath turnover flaps were used in nine of the 18 nontrauma and two of the 11 trauma patients, all of whom were unsuitable for standard fascial closure of prolonged visceral edema; the respective mean intervals from initial laparotomy to fascial closure were 9.4 and 18 days. Of the 11 patients with flaps, ten survived without fascial dehiscence or herniation (maximum follow-up: 65 months). Conclusions: Early fascial closure using the anterior rectus abdominis sheath turnover flap may reduce the need for skin grafting and subsequent abdominal wall reconstruction. This approach can be considered as an alternative technique in the early management of patients with open abdomen. ? 2006 Société Internationale de Chirurgie.","author":[{"dropping-particle":"","family":"Kushimoto","given":"Shigeki","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamamoto","given":"Yasuhiro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aiboshi","given":"Junichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ogawa","given":"Futoshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koido","given":"Yuichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yoshida","given":"Ryusuke","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kawai","given":"Makato","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"World Journal of Surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2007"]]},"page":"2-8","title":"Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management","type":"article-journal","volume":"31"},"uris":[""]}],"mendeley":{"formattedCitation":"(Kushimoto et al., 2007)","plainTextFormattedCitation":"(Kushimoto et al., 2007)","previouslyFormattedCitation":"[18]"},"properties":{"noteIndex":0},"schema":""}(Kushimoto et al., 2007). In conclusion; autologous grafting with external rectus sheath flap, as a technique to reconstruct large inguinal defects, is a simple performance procedure, with low cost impact and no expected complications. The muscle flap could show a promising result as a biological alternative for the mesh in large abdominal defect. The findings of the current study also showed ERF-PRP's dominance over the ERF.Conflict of interest The authors declare that they have no conflicts of interest to disclose.AcknowledgmentsWe sincerely thank the staff at veterinary hospitals at college of Veterinary Medicine, Benha University for help during the experiment. Figure LegendsFigure 1. Illustrated admitted cases and step sequence of surgical correction of scrotal hernia by autologous graft using external rectus flap with and without PRP. A (admitted cases suffering from unilateral scrotal hernia); B (skin incision); C (Flap dissection); D (closure of the hernial ring with the flap); E (addition of activated PRP at the surface and periphery of turned over flap) and F (wound at 10th day postoperative). P (penis), S (scrotal swelling), T (thigh medial side), F (flap), R (inguinal ring) and M (rectus abdominis muscle).Figure 2. Ultrasonographic examination of ERF at 7th (A), 21th (B), 42th (C) days postoperative. Ultrasonographic examination of ERF-PRP at 7th (D), 21th (E), 42th (F) days postoperative. Arrows (flap), R (rectus abdominis muscle) and Sc (subcutaneous tissue edema), white circle (points of adhesion).Figure 3. Doppler ultrasonographic examination of ERF at 7th (A), 21th (B) & 42th (C) days postoperative. Doppler ultrasonographic examination of ERF-PRP at 7th (D), 21th (E) & 42th (F) days postoperative.References Abdelwahed, R. et al. 2012. Chest wall resection following soft tissue tumor resection in dogs withan autogenous muscle flap. AJVS, 37 (1) November. 2012: 237-244.Agarwal, A., Gupta, N. D., and Jain, A., 2016. Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trial. Acta Odontol. Scand. 74, 36–43. doi:10.3109/00016357.2015.1035672.Baumann, D. P., and Butler, C. E., 2012. Bioprosthetic mesh in abdominal wall reconstruction. Semin. Plast. Surg. 26, 18–24. doi:10.1055/s-0032-1302461.Bielecki, T. M., Gazdzik, T. S., Arendt, J., Szczepanski, T., Król, W., and Wielkoszynski, T., 2007. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: An in vitro study. J. Bone Jt. Surg. - Ser. B 89, 417–420. doi:10.1302/0301-620X.89B3.18491.Brossi, P. M., Moreira, J. J., Machado, T. S. L., and Baccarin, R. Y. A., 2015. 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Vet. Med. (Praha). 59, 163–180. doi:10.17221/7478-VETMED.Usher F.C., 1962. Hernia repair with Marlex mesh: an analysis of 541 cases. Arch Surg 84, 2–5.Van Eps, J., Fernandez-Moure, J., Cabrera, F., Wang, X., Karim, A., Corradetti, B., 2016. Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with StratticeTM mesh in a rodent ventral hernia model. Surg. Endosc. 30, 3239–3249. doi:10.1007/s00464-015-4645-4.Xu, H., Wan, H., Sandor, M., Qi, S., Ervin, F., Harper, J. R., et al., 2008). Host response to human acellular dermal matrix transplantation in a primate model of abdominal wall repair. Tissue Eng. - Part A 14, 2009–2019. doi:10.1089/ten.tea.2007.0316.Zuffova, K., Krisova, S., and Zert, Z., 2013. Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing Thoroughbreds. Vet. Med. (Praha). 58, 230–239. doi:10.17221/6761-VETMED. ................
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