Allohernioplasty with the introduction of platelet-rich plasma (PRP) in a chronic experiment: features of the reparative process

Introduction. Mesh has become the standard for herniorrhaphy – it helps to reduce recurrence and the development of side effects. The regulation of immunocompetent cells migration determines the therapeutic strategy to modulate the inflammatory response. Aim. To conduct a clinical and morphological analysis of the effect of platelet-rich plasma (PRP) on the course of reparative process in allogernioplasty. Materials and methods. 47 Wistar rats were divided into 3 groups: with PRP in optimal dosage (n = 15), maximum dosage (n = 15), without PRP (n = 15), two rats were used for terminal blood sampling for PRP manufacturing. All animals were operated on, creating an aponeurosis defect that was closed with a mesh implant followed by PRP application. The severity of postoperative pain syndrome was assessed using the developed by us summary scale of physiological status, behavioral reactions, and facial expressions; the state of the postoperative scar, the terms of postoperative wound hair loss were evaluated. Material for morphologic evaluation was taken on days 7, 14, 21, 28, 60. Results and discussion. The positive effects of PRP were morphologically confirmed. The biopsy specimens after PRP revealed: absence of rough fibrosis, more abundant vascularization, early formation of a “delicate” scar and lymphatic collectors in the peri-implant zone, absence or minimal expression of degenerative changes of nerve trunks. There is a reduction of the alteration phase and acceleration of repair processes. In animals of group PRP overdose in the postoperative period a pronounced destructive-inflammatory reaction with microbial contamination prevailed, up to the formation of chronic abscesses. We attribute these changes to excessive recruitment of neutrophils and macrophages secreting proteases and proinflammatory cytokines. Conclusion. The use of PRP in the optimal dosage allows to improve the integration of the mesh implant during allogerniopalasty, prevents rough fibrosis, deformation and shriveling of the implant; reduces the probability of chronic pain syndrome development.