Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Platelet rich plasma, adipose tissue micrografts, and regenerative mimetic factors for abdominal wall defect reconstruction: Experimental study protocol
Konstantinos Zapsalis, Orestis Ioannidis, Christos Xylas, Konstantinos Siozos, Georgios Gemousakakis, Elissavet Anestiadou, Savvas Symeonidis, Stefanos Bitsianis, Efstathios Kotidis, Angeliki Cheva, Chryssa Bekiari, Antonia Loukousia, Konstantinos Angelopoulos, Manousos-Georgios Pramateftakis, Ioannis Mantzoros, Freiderikos Tserkezidis, Barbara Driagka, Stamatios Angelopoulos
Konstantinos Zapsalis, Orestis Ioannidis, Christos Xylas, Konstantinos Siozos, Georgios Gemousakakis, Elissavet Anestiadou, Savvas Symeonidis, Stefanos Bitsianis, Efstathios Kotidis, Konstantinos Angelopoulos, Manousos-Georgios Pramateftakis, Ioannis Mantzoros, Freiderikos Tserkezidis, Barbara Driagka, Stamatios Angelopoulos, Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Kentrikí Makedonía, Greece
Angeliki Cheva, Antonia Loukousia, Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Kentrikí Makedonía, Greece
Chryssa Bekiari, Laboratory of Anatomy and Histology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Kentrikí Makedonía, Greece
Author contributions: Zapsalis K conceived the study design; Ioannidis O contributed to the conceptualization of the protocol and critical revision of the manuscript; Xylas C developed the protocol methodology and contributed to writing and editing; Siozos K assisted with protocol refinement and manuscript preparation; Gemousakakis G secured resources and funding support; Anestiadou E developed laboratory and analysis protocols; Symeonidis S oversaw protocol development and critical review of the manuscript; Bitsianis S contributed to protocol visualization and drafting; Kotidis E provided expertise in clinical aspects of the protocol; Cheva A conducted literature review and assisted in protocol drafting; Bekiari C contributed to methodological and experimental planning; Loukousia A supported data structuring for protocol implementation; Angelopoulos K reviewed and refined experimental design; Pramateftakis MG provided clinical guidance and input; Mantzoros I reviewed and provided input on protocol strategy; Tserkezidis F validated protocol structure and provided theoretical input; Driagka B assisted in participant coordination and logistics planning; Angelopoulos S supervised protocol validation and contributed to manuscript editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study titled "Platelet rich plasma, adipose tissue micrografts, and regenerative mimetic factors for abdominal wall defect reconstruction: Experimental Study Protocol" has been submitted for ethical review and approval to the Veterinary Service of the Aristotle University of Thessaloniki (AUTH) under protocol No. 81/01-07-2024.
Institutional animal care and use committee statement: The animals will be housed in groups under fully controlled conditions in individually ventilated cages at the Accredited Animal Facility of the Laboratory of Anatomy, Histology and Embryology of AUTH's Veterinary School (accreditation No. EL54BIO23). All procedures will comply with the revised European and National Regulations (European Community Council directive 86/609/EEC; Presidential Degree 56/2013). The experiment received approval from the Federal Authorities (Veterinary Directorate of Thessaloniki; AUTH's Ethics Committee).
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Data sharing statement: None.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Konstantinos Zapsalis, MD, MSc, Doctor, Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 57010, Kentrikí Makedonía, Greece.
konstzapsalis@yahoo.gr
Received: July 12, 2024
Revised: November 17, 2024
Accepted: December 12, 2024
Published online: June 20, 2025
Processing time: 277 Days and 20.4 Hours
BACKGROUND
Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice, posing a significant burden on healthcare systems despite advances in education and technology. Surgical techniques, primarily involving the use of mesh to cover the abdominal wall gap, are widely used as a standard intervention strategy.
AIM
To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix [ReGeneraTing Agent (RGTA)], adipose tissue micrografts (ATM), and platelet rich plasma (PRP) as regenerative agents.
METHODS
Regenerative agents such as RGTA, ATM, and PRP are gaining popularity. ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells. RGTAs are heparan sulfate (HS) mimetics that replace degraded HSs in damaged tissue, enhancing the quality and speed of repair. PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production. An acellular dermal matrix is a biological implant free of cellular or antigenic components, making it an excellent material for reconstructive surgery. Polyglactin is a synthetic, absorbable mesh that loses 50% of its strength after fourteen days, providing initial support for new tissue regeneration before being completely absorbed.
RESULTS
Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus. They will be divided into sixteen groups, each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments. A collagen-elastin matrix will be used to join the aponeurosis edges, with an absorbable polyglactin mesh anchored over it. Samples will be taken for macroscopic, histological, and immunohistochemical evaluation of tissue regeneration.
CONCLUSION
Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall, potentially reducing the frequency and complications of incisional hernias. This approach could offer a more economical and efficient treatment option compared to current costly methods.
Core Tip: This study protocol explores innovative regenerative strategies for abdominal wall defect repair using a combination of platelet rich plasma, adipose tissue micrografts, and regenerative glycosaminoglycan mimetics (ReGeneraTing Agent). By leveraging their unique properties in promoting cell proliferation and enhancing extracellular matrix repair, these agents are introduced into denervated tissue following a controlled abdominal wall excision in rats. Coupled with collagen-elastin matrices and absorbable polyglactin mesh, this approach aims to improve tissue healing, minimize complications, and reduce the burden of incisional hernias, offering an alternative to current mesh-based interventions.
