Mesh fixation with autologous platelet-rich fibrin sealant in inguinal hernia repair.

BACKGROUND: Chronic pain is the main complication following inguinal hernia repair. A possible explanatory factor is the suture fixation of the mesh. Glue fixation might overcome this problem. Albeit at a very low frequency, human and bovine components of fibrin sealants currently available could contain blood-borne pathogens. Autologous platelet-rich fibrin sealant (P-RFS) eliminates this risk and has additional advantages such as hemostatic and antibacterial effects. Therefore, its feasibility was assessed in inguinal hernia repair, with a focus on pain. METHODS: In 22 patients with primary inguinal hernia, the mesh was fixated with P-RFS. Data included operative variables, complications, pain scores and neurological examinations. Long-term follow-up was 22.2 months (SD 2.2) postoperatively. RESULTS: After 2 weeks, visual analogue scale and disability pain scores were lower than they were preoperatively. Complications at 3 months were 1 recurrence, 1 chronic pain and 6 sensory disturbances. At the last clinical evaluation, the recurrence was planned for repair due to discomfort. No chronic pain, sensory disorders or discomfort was reported at long-term follow-up. CONCLUSION: Mesh fixation with autologous P-RFS is feasible. If there is a preference for autologous material, P-RFS is indicated. If glue fixation becomes standard, further randomized studies are warranted for this alternative.

Differences in platelet growth factor release and leucocyte kinetics during autologous platelet gel formation.

Three commercial systems for whole blood separation were compared to obtain the buffy coat composed of platelet-rich plasma (BC-PRP) and leucocytes . These samples of the buffy coat were used to make a platelet gel (PG), which was used to measure platelet growth factor (PGF) release, to perform a white blood cell (WBC) count and to measure myeloperoxidase (MPO) release from WBCs. Aliquots of whole blood obtained from ten volunteers were distributed either to a blood cell separator (The Electa Cell-Separator, E-CS) or to a tabletop centrifuge (Gravitational Platelet Sequestration System, GPS) to prepare the BC-PRP. The third system combines the BC-PRP production by E-CS with a micro porous filter (Autologous Growth Factor filter, AGF) to enrich for the BC-PRP. Autologous thrombin was used to activate the BC-PRP and to prepare the PG and subsequently to degranulate the platelet concentrate. Platelet-derived growth factor-AB and transforming growth factor-beta1 were present in high levels after thrombin activation of the E-CS or GPS prepared samples. However, the AGF prepared samples released their growth factors before thrombin activation. The WBCs were significantly increased with each of the three systems. Contrary to the AGF, no leucocyte degranulation occurred with the E-CS or GPS prepared samples, based upon the low MPO concentrations in the BC-PRP. The three types of apparatus had different harvesting capacities for collecting the enriched platelets and the release of high concentrations of PGF. When the E-CS and GPS, but not the AGF, were used, low levels of MPO were maintained in the PG, which potentially contributes to antimicrobial properties of platelet gel at the site of application.

Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is often associated with a considerable amount of post-operative blood loss, necessitating the transfusion of allogeneic blood, which can add to the complications. Optimization of strategies to reduce the need for blood transfusion is desired. This study was designed to evaluate the efficacy of autologous platelet gel and fibrin sealant in unilateral TKA. METHODS: Consecutive patients were operated on and assigned to the study and control groups. Study group patients (n = 85) were operated on according to our standard TKA protocol, with the application of autologous platelet gel and fibrin sealant on the wound tissues at the end of surgery. Eighty patients were operated on according to the same protocol, but without the use of platelet gel and fibrin sealant, and served as the control group. All blood transfusions, occurrence of wound leakage, wound healing disturbances and incidences of post-operative infections were recorded. RESULTS: Patients in the treatment group had a significantly higher post-operative haemoglobin level (11.3 vs. 8.9 g/dl, respectively) and a decreased need for allogeneic blood products (0.17 vs. 0.52 units, respectively) than those in the control group (P < 0.001). The incidences of wound leakage and wound healing disturbance were significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. Four patients in the control group, who received blood products, developed wound infection. The hospital stay was decreased by 1.4 +/- 1.5 days for patients in the treatment group (P < 0.001). CONCLUSION: Peri-operatively applied platelet gel and fibrin sealant may reduce the incidence of allogeneic blood transfusions and complications associated with TKA.