Iranian Journal of Veterinary Surgery

Iranian Journal of Veterinary Surgery

Influence of Injectable Platelet-Rich Fibrin on ex vivo Leak Pressure of Canine Enterotomy

Document Type : Original Article

Authors
Ali Heydari Azar Heris 1
Davoud Kazemi 2
1 DVM Graduate, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
2 Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
10.30500/ivsa.2024.427976.1380
Abstract
Injectable platelet rich fibrin, the latest innovation among platelet concentrates is obtained by centrifugation of whole blood without any anticoagulants. The initially liquid product is later converted into gel form due to conversion of fibrinogen into fibrin. This feature allows it to be used in injectable form or as topical spray. Incisional dehiscence and leakage is a potentially fatal postoperative complication of enterotomy. This study was conducted to investigate whether injectable platelet rich fibrin could be used as suture line reinforcement method in canine enterotomy. It was hypothesized that topically applied injectable platelet rich fibrin could increase the leakage pressure of enterotomy incisions. A total of 28 enterotomy incisions measuring 3 cm in length were created on the antimesenteric border of jejunum in canine cadaveric samples. The incisions were sutured with simple interrupted or simple continuous patterns and the suture line was reinforced by topical injectable platelet rich fibrin in treatment groups. Leak testing was conducted immediately and 15 minutes after suture placement in control and treatment samples respectively and initial leakage pressure and maximum intraluminal pressure was recorded along with leakage location. Although statistically insignificant, application of injectable platelet rich fibrin in the simple continuous treatment group increased the mean initial leakage pressure in comparison to simple continuous control group (15 ± 7.228 vs. 11.67 ± 26.17). Mean maximum intraluminal pressure was increased in both simple interrupted (46.29 ± 30.53 vs. 39 ± 34.54) and simple continuous (47.78 ± 9.497 vs. 35.67 ± 31.46) treatment groups in comparison to their respective control groups. Leakage was observed from the incision line and from the needle holes outside the incision line in simple interrupted and simple continuous sutured incisions respectively. Although the results indicated the feasibility of using this method but in vivo investigations are required to determine whether it could be used in clinical cases.
Keywords
Injectable platelet-rich fibrin
Enterotomy
Dog
Leakage pressure

Subjects

  1. Baines S. Small intestinal surgery 2. Techniques. In Practice. 2000; 22(10): 574-592. doi: 10.1136/inpract.22.10.574
  2. Papazoglou LG, Patsikas MN, Rallis T. Intestinal foreign bodies in dogs and cats. Compendium on Continuing Education for the Practicing Veterinarian. 2003; 25(11): 830-845.
  3. Murgia D. Surgery of the small intestine in dogs and cats. Companion Animal. 2013; 18(3): 114-119. doi: 10.12968/coan.2013.18.4.158
  4. Lopez DJ, Holm SA, Korten B, Baum JI, Flanders JA, Sumner JP. Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs. Journal of the American Veterinary Medical Association. 2021; 258(12): 1378-1385. doi: 10.2460/javma.258.12.1378
  5. Bowlt K. Complications of intestinal surgery. Companion Animal, 2012; 17(9):13-16. doi: 10.1111/j.2044-3862.2012.00250.x
  6. Ellison GW, Case JB, Regier PJ. Intestinal surgery in small animals: historical foundations, current thinking, and future horizons. Veterinary Surgery. 2019; 48(7): 1171-1180. doi: 10.1111/vsu.13275
  7. Strelchik A, Coleman MC, Scharf VF, Stoneburner RM, Mankin KM. Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs. Journal of the American Veterinary Medical Association. 2019; 255(6): 695-699. doi: 10.2460/javma.255.6.695
  8. Maxwell EA, Dugat DR, Waltenburg M, Upchurch D, Soto‐Elias P, Duffy DJ, Spector D, Petrovsky B, Payton M. Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: a retrospective study by the Society of Veterinary Soft Tissue Surgery. Veterinary Surgery. 2021; 50(1): 177-185. doi: 10.1111/vsu.13520
  9. Gill SS, Buote NJ, Peterson NW, Bergman PJ. Factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs. Journal of the American Veterinary Medical Association. 2019; 255(5): 569-573. doi: 10.2460/javma.255.5.569
  10. Shales CJ, Warren J, Anderson DM, Baines SJ, White RA. Complications following full‐thickness small intestinal biopsy in 66 dogs: a retrospective study. Journal of Small Animal Practice. 2005; 46(7): 317-321. doi: 10.1111/j.1748-5827.2005.tb00326.x
  11. Saile K, Boothe HW, Boothe DM. Saline volume necessary to achieve predetermined intraluminal pressures during leak testing of small intestinal biopsy sites in the dog. Veterinary Surgery. 2010; 39(7): 900-903. doi: 10.1111/j.1532-950X.2010.00730.x
  12. Culbertson TF, Smeak DD, Rao S. Volume of saline (0.9% NaCl) solution required to reach maximum peristaltic pressure in cadaveric intact jejunal specimens from dogs of various sizes. American Journal of Veterinary Research. 2021; 82(12): 988-995. doi: 10.2460/ajvr.21.05.0066
  13. Annabi N, Yue K, Tamayol A, Khademhosseini A. Elastic sealants for surgical applications. European Journal of Pharmaceutics and Biopharmaceutics. 2015; 95: 27-39. doi: 10.1016/j.ejpb.2015.05.022
  14. Uppal A, Pigazzi A. New technologies to prevent anastomotic leak. Clinics in Colon and Rectal Surgery. 2021; 34(06): 379-384. doi: 10.1055/s-0041-1735268
  15. Wang X, Zhang Y, Choukroun J, Ghanaati S, Miron RJ. Effects of an injectable platelet-rich fibrin on osteoblast behavior and bone tissue formation in comparison to platelet-rich plasma. Platelets. 2018; 29(1): 48-55. doi: 10.1080/09537104.2017.1293807
  16. Varela HA, Souza JC, Nascimento RM, Araújo RF, Vasconcelos RC, Cavalcante RS, Guedes PM, Araújo AA. Injectable platelet rich fibrin: cell content, morphological, and protein characterization. Clinical Oral Investigations. 2019; 23: 1309-18. doi: 10.1007/s00784-018-2555-2
  17. Hendriks T, Mastboom WJ. Healing of experimental intestinal anastomoses: parameters for repair. Diseases of the Colon & Rectum. 1990; 33(10): 891-901.
  18. Mutascio LM, Breur GJ, Moore GE, Simons MC. Effects of a surgical sealant on leakage pressure and circumference of fresh canine cadaver small intestinal anastomoses. American Journal of Veterinary Research. 2018; 79(12): 1335-1340. doi: 10.2460/ajvr.79.12.1335
  19. Jones CT, Chen CY, Campbell BG, Fransson BA. Assessment of leakage pressure following enterotomy closure reinforced by tissue adhesive in a caprine cadaver model. New Zealand Veterinary Journal. 2017; 65(5): 248-251. doi: 10.1080/00480169.2017.1344586
  20. Hansen LA, Monnet EL. Evaluation of serosal patch supplementation of surgical anastomoses in intestinal segments from canine cadavers. American Journal of Veterinary Research. 2013; 74(8): 1138-1141. doi: 10.2460/ajvr.74.8.1138
  21. Kimura M, Terashita Y. Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: suture line reinforcement of the weak point of the anastomosis. Annals of Medicine and Surgery. 2016; 6: 50-55. doi: 10.1016/j.amsu.2016.01.034
  22. Kieves NR, Krebs AI, Zellner EM. A comparison of ex vivo leak pressures for four enterotomy closures in a canine model. Journal of the American Animal Hospital Association. 2018; 54(2): 71-76. doi: 10.5326/JAAHA-MS-6459
  23. Ding ZY, Tan Y, Peng Q, Zuo J, Li N. Novel applications of platelet concentrates in tissue regeneration. Experimental and Therapeutic Medicine. 2021; 21(3): 1-12. doi: 10.3892/etm.2021.9657
  24. Giannotti L, Di Chiara Stanca B, Spedicato F, Nitti P, Damiano F, Demitri C, Calabriso N, Carluccio MA, Palermo A, Siculella L, Stanca E. Progress in regenerative medicine: exploring autologous platelet concentrates and their clinical applications. Genes. 2023; 14(9): 1-21. doi: 10.3390/genes14091669
  25. Aeschlimann KA, Mann FA, Middleton JR, Belter RC. Comparison of enterotomy leak pressure among fresh, cooled, and frozen-thawed porcine jejunal segments. American Journal of Veterinary Research. 2018; 79(5): 576-580. doi: 10.2460/ajvr.79.5.576
  26. Regier PJ, Fealey MJ, Kim SE, Case JB, Garcia-Pereira F. Comparison of intestinal leak pressure between cadaveric canine and commercial synthetic intestinal tissue that did and did not undergo enterotomy. American Journal of Veterinary Research. 2020; 81(10): 827-831. doi: 10.2460/ajvr.81.10.827
  27. Curran KM, Fransson BA, Gay JM. A comparison of in situ and in vitro techniques for bursting pressure testing of canine jejunum. American Journal of Veterinary Research. 2010; 71(3): 370-373. doi: 10.2460/ajvr.71.3.370
  28. Fealey MJ, Regier PJ, Steadman BS C, Brad Case J, Garcia‐Pereira F. Initial leak pressures of four anastomosis techniques in cooled cadaveric canine jejunum. Veterinary Surgery. 2020; 49(3): 480-486. doi: 10.1111/vsu.13392
  29. Mullen KM, Regier PJ, Waln M, Colee J. Ex vivo comparison of leak testing of canine jejunal enterotomies: saline infusion versus air insufflation. Veterinary Surgery. 2021; 50(6): 1257-1266. doi: 10.1111/vsu.13652
  30. Duffy DJ, Chang YJ, Balko JA, Moore GE. Effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens. American Journal of Veterinary Research. 2020; 81(3): 220-226. doi: 10.2460/ajvr.81.3.220
  31. Ellison GW. Complications of gastrointestinal surgery in companion animals. Veterinary Clinics: Small Animal Practice. 2011; 41(5): 915-934. doi: 10.1016/j.cvsm.2011.05.006
  32. Rijcken E, Sachs L, Fuchs T, Spiegel HU, Neumann PA. Growth factors and gastrointestinal anastomotic healing. Journal of Surgical Research. 2014; 187(1): 202-210. doi: 10.1016/j.jss.2013.10.013
  33. Ozcay N, Ozdemir H, Besim H. Role of platelet-rich fibrin on intestinal anastomosis wound healing in a rat. Biomedical Materials. 2018; 13(4): 045006. doi: 10.1088/1748-605X/aab8e1
  34. Albahrawy M, Abass M, Mosbah E, Karrouf G, Awadin W, Zaghloul A. Reinforcement of colon anastomosis healing with leukocyte platelet-rich fibrin in rabbit model. Life Sciences. 2023; 333: 122146. doi: 10.1016/j.1fs.2023.122146
Iranian Journal of Veterinary Surgery
Volume 19, Issue 2 - Serial Number 41
October 2024
Pages 125-130

  • Receive Date 30 November 2023
  • Revise Date 31 December 2023
  • Accept Date 08 January 2024
  • First Publish Date 08 January 2024