Incisional hernia is the most common postoperative complication, affecting up to 20% of patients after abdominal surgery. Insertion of a synthetic surgical mesh has become the standard of care in ventral hernia repair. However, the implementation of a mesh does not reduce the risk of recurrence and the onset of hernia recurrence is only delayed by 2-3 years. Nowadays, more than 100 surgical meshes are available on the market, with polypropylene the most widely used for ventral hernia repair. Nonetheless, the ideal mesh does not exist yet; it still needs to be developed. Polycaprolactone nanofibers appear to be a suitable material for different kinds of cells, including fibroblasts, chondrocytes, and mesenchymal stem cells. The aim of the study reported here was to develop a functionalized scaffold for ventral hernia regeneration. We prepared a novel composite scaffold based on a polypropylene surgical mesh functionalized with poly-ε-caprolactone (PCL) nanofibers and adhered thrombocytes as a natural source of growth factors. In extensive in vitro tests, we proved the biocompatibility of PCL nanofibers with adhered thrombocytes deposited on a polypropylene mesh. Compared with polypropylene mesh alone, this composite scaffold provided better adhesion, growth, metabolic activity, proliferation, and viability of mouse fibroblasts in all tests and was even better than a polypropylene mesh functionalized with PCL nanofibers. The gradual release of growth factors from biocompatible nanofiber-modified scaffolds seems to be a promising approach in tissue engineering and regenerative medicine.

Department of Surgery 2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Institute of Biophysics 2nd Faculty of Medicine Charles University Prague Prague Czech Republic ; Laboratory of Tissue Engineering Institute of Experimental Medicine Academy of Sciences of the Czech Republic Prague Czech Republic

Institute of Biophysics 2nd Faculty of Medicine Charles University Prague Prague Czech Republic ; Laboratory of Tissue Engineering Institute of Experimental Medicine Academy of Sciences of the Czech Republic Prague Czech Republic ; Faculty of Biomedical Engineering Czech Technical University Prague Kladno Czech Republic

Laboratory of Tissue Engineering Institute of Experimental Medicine Academy of Sciences of the Czech Republic Prague Czech Republic ; University Center for Energy Efficient Buildings The Czech Technical University Prague Bustehrad Czech Republic

University Center for Energy Efficient Buildings The Czech Technical University Prague Bustehrad Czech Republic

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Sugerman HJ, Kellum JM, Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171(1):80–84. PubMed

Höer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg. 2002;73(5):474–480. German. PubMed

Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–583. discussion 583–575. PubMed PMC

Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237(1):129–135. PubMed PMC

Vrijland WW, Bonthuis F, Steyerberg EW, Marquet RL, Jeekel J, Bonjer HJ. Peritoneal adhesions to prosthetic materials: choice of mesh for incisional hernia repair. Surg Endosc. 2000;14(10):960–963. PubMed

Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL. Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite. Surg Endosc. 2007;21(4):629–633. PubMed

Losanoff JE, Richman BW, Jones JW. Entero-colocutaneous fistula: a late consequence of polypropylene mesh abdominal wall repair: case report and review of the literature. Hernia. 2002;6(3):144–147. PubMed

Jezupovs A, Mihelsons M. The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg. 2006;30(12):2270–2278. discussion 2279–2280. PubMed

Usher FC, Ochsner J, Tuttle LL., Jr Use of marlex mesh in the repair of incisional hernias. Am Surg. 1958;24(12):969–974. PubMed

Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–398. PubMed

Shankaran V, Weber DJ, Reed RL, 2nd, Luchette FA. A review of available prosthetics for ventral hernia repair. Ann Surg. 2011;253(1):16–26. PubMed

Ebersole GC, Buettmann EG, MacEwan MR, et al. Development of novel electrospun absorbable polycaprolactone (PCL) scaffolds for hernia repair applications. Surg Endosc. 2012;26(10):2717–2728. PubMed

Klinge U, Klosterhalfen B. Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia. 2012;16(3):251–258. PubMed PMC

Coda A, Lamberti R, Martorana S. Classification of prosthetics used in hernia repair based on weight and biomaterial. Hernia. 2012;16(1):9–20. PubMed

Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J. Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc. 2006;20(8):1320–1325. PubMed

Catena F, Ansaloni L, Gazzotti F, et al. Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia. 2007;11(1):57–60. PubMed

Butler CE, Prieto VG. Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction. Plast Reconstr Surg. 2004;114(2):464–473. PubMed

Sato T, Chen G, Ushida T, et al. Evaluation of PLLA–collagen hybrid sponge as a scaffold for cartilage tissue engineering. Mater Sci Eng C Mater Biol Appl. 2004;24(3):365–372.

Khil MS, Bhattarai SR, Kim HY, Kim SZ, Lee KH. Novel fabricated matrix via electrospinning for tissue engineering. J Biomed Mat Res B Appl Biomater. 2005;72(1):117–124. PubMed

Kim SH, Turnbull J, Guimond S. Extracellular matrix and cell signalling: the dynamic cooperation of integrin, proteoglycan and growth factor receptor. J Endocrinol. 2011;209(2):139–151. PubMed

Kim TG, Park TG. Surface functionalized electrospun biodegradable nanofibers for immobilization of bioactive molecules. Biotechnol Prog. 2006;22(4):1108–1113. PubMed

Jayakumar R, Prabaharan M, Nair SV, Tamura H. Novel chitin and chitosan nanofibers in biomedical applications. Biotechnol Adv. 2010;28(1):142–150. PubMed

Jakubova R, Mickova A, Buzgo M, et al. Immobilization of thrombocytes on PCL nanofibres enhances chondrocyte proliferation in vitro. Cell Prolif. 2011;44(2):183–191. PubMed PMC

Hutmacher DW, Schantz T, Zein I, Ng KW, Teoh SH, Tan KC. Mechanical properties and cell cultural response of polycaprolactone scaffolds designed and fabricated via fused deposition modeling. J Biomed Mater Res. 2001;55(2):203–216. PubMed

Kweon H, Yoo MK, Park IK, et al. A novel degradable polycaprolactone networks for tissue engineering. Biomaterials. 2003;24(5):801–808. PubMed

Thapa A, Webster TJ, Haberstroh KM. Polymers with nano-dimensional surface features enhance bladder smooth muscle cell adhesion. J Biomed Mater Res A. 2003;67(4):1374–1383. PubMed

Venugopal J, Ramakrishna S. Biocompatible nanofiber matrices for the engineering of a dermal substitute for skin regeneration. Tissue Eng. 2005;11(5–6):847–854. PubMed

Chen M, Patra PK, Warner SB, Bhowmick S. Role of fiber diameter in adhesion and proliferation of NIH 3T3 fibroblast on electrospun polycaprolactone scaffolds. Tissue Eng. 2007;13(3):579–587. PubMed

Plencner M, East B, Tonar Z, et al. Abdominal closure reinforcement by using polypropylene mesh functionalized with poly-ε-caprolactone nanofibers and growth factors for prevention of incisional hernia formation. Int J Nanomedicine. 2014;9:3263–3277. PubMed PMC

Williamson MR, Adams EF, Coombes AG. Gravity spun polycaprolactone fibres for soft tissue engineering: interaction with fibroblasts and myoblasts in cell culture. Biomaterials. 2006;27(7):1019–1026. PubMed

Rampichová M, Chvojka J, Buzgo M, et al. Elastic three-dimensional poly (ε-caprolactone) nanofibre scaffold enhances migration, proliferation and osteogenic differentiation of mesenchymal stem cells. Cell Prolif. 2013;46(1):23–37. PubMed PMC

Venugopal JR, Zhang Y, Ramakrishna S. In vitro culture of human dermal fibroblasts on electrospun polycaprolactone collagen nanofibrous membrane. Artif Organs. 2006;30(6):440–446. PubMed

Hromadka M, Collins JB, Reed C, et al. Nanofiber applications for burn care. J Burn Care Res. 2008;29(5):695–703. PubMed

Buzgo M, Jakubova R, Mickova A, et al. Time-regulated drug delivery system based on coaxially incorporated platelet α-granules for biomedical use. Nanomedicine (Lond) 2013;8(7):1137–1154. PubMed

Drengk A, Zapf A, Stürmer EK, Stürmer KM, Frosch KH. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells, tissues, organs. 2009;189(5):317–326. PubMed

Nikolidakis D, Jansen JA. The biology of platelet-rich plasma and its application in oral surgery: literature review. Tissue Eng Part B Rev. 2008;14(3):249–258. PubMed

Plachokova AS, Nikolidakis D, Mulder J, Jansen JA, Creugers NH. Effect of platelet-rich plasma on bone regeneration in dentistry: a systematic review. Clin Oral Implants Res. 2008;19(6):539–545. PubMed

Nauta A, Gurtner GC, Longaker MT. Wound healing and regenerative strategies. Oral Dis. 2011;17(6):541–549. PubMed

Lukáš D, Sarkar A, Martinová L, et al. Textiles Progress. 2. Vol. 41. Abingdon: Taylor and Francis; 2009. (Physical principles of electrospinning (electrospinning as a nano-scale technology of the twenty-first century)).

Baenziger NL, Brodie GN, Majerus PW. A thrombin-sensitive protein of human platelet membranes. Proc Natl Acad Sci U S A. 1971;68(1):240–243. PubMed PMC

Mickova A, Buzgo M, Benada O, et al. Core/Shell nanofibers with embedded liposomes as a drug delivery system. Biomacromolecules. 2012;13(4):952–962. PubMed

Cobb WS, Peindl RM, Zerey M, Carbonell AM, Heniford BT. Mesh terminology 101. Hernia. 2009;13(1):1–6. PubMed

Williams JM, Adewunmi A, Schek RM, et al. Bone tissue engineering using polycaprolactone scaffolds fabricated via selective laser sintering. Biomaterials. 2005;26(23):4817–4827. PubMed

Guillaume O, Lavigne JP, Lefranc O, Nottelet B, Coudane J, Garric X. New antibiotic-eluting mesh used for soft tissue reinforcement. Acta Biomater. 2011;7(9):3390–3397. PubMed

Bölgen N, Vargel I, Korkusuz P, Menceloğlu YZ, Pişkin E. In vivo performance of antibiotic embedded electrospun PCL membranes for prevention of abdominal adhesions. J Biomed Mater Res B Appl Biomater. 2007;81(2):530–543. PubMed

Zhao W, Ju YM, Christ G, Atala A, Yoo JJ, Lee SJ. Diaphragmatic muscle reconstruction with an aligned electrospun poly(ε-caprolactone)/collagen hybrid scaffold. Biomaterials. 2013;34(33):8235–8240. PubMed

Ma Z, Kotaki M, Inai R, Ramakrishna S. Potential of nanofiber matrix as tissue-engineering scaffolds. Tissue Eng. 2005;11(1–2):101–109. PubMed

Deeken CR, Abdo MS, Frisella MM, Matthews BD. Physicomechanical evaluation of absorbable and nonabsorbable barrier composite meshes for laparoscopic ventral hernia repair. Surg Endosc. 2011;25(5):1541–1552. PubMed

Tabata II. The importance of drug delivery systems in tissue engineering. Pharm Sci Technolo Today. 2000;3(3):80–89. PubMed

Richardson TP, Peters MC, Ennett AB, Mooney DJ. Polymeric system for dual growth factor delivery. Nat Biotechnol. 2001;19(11):1029–1034. PubMed

Rai B, Teoh SH, Ho KH. An in vitro evaluation of PCL-TCP composites as delivery systems for platelet-rich plasma. J Control Release. 2005;107(2):330–342. PubMed

Babensee JE, McIntire LV, Mikos AG. Growth factor delivery for tissue engineering. Pharm Res. 2000;17(5):497–504. PubMed

Tonti GA, Mannello F. From bone marrow to therapeutic applications: different behaviour and genetic/epigenetic stability during mesenchymal stem cell expansion in autologous and foetal bovine sera? Int J Dev Biol. 2008;52(8):1023–1032. PubMed

Anitua E, Sánchez M, Zalduendo MM, et al. Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif. 2009;42(2):162–170. PubMed PMC

Creeper F, Ivanovski S. Effect of autologous and allogenic platelet- rich plasma on human gingival fibroblast function. Oral Dis. 2012;18(5):494–500. PubMed

Passaretti F, Tia M, D’Esposito V, et al. Growth-promoting action and growth factor release by different platelet derivatives. Platelets. 2014;25(4):252–256. PubMed

Blair P, Flaumenhaft R. Platelet alpha-granules: basic biology and clinical correlates. Blood Rev. 2009;23(4):177–189. PubMed PMC

Prosecká E, Rampichová M, Litvinec A, et al. Collagen/hydroxyapatite scaffold enriched with polycaprolactone nanofibers, thrombocyte-rich solution and mesenchymal stem cells promotes regeneration in large bone defect in vivo. J Biomed Mater Res A. 2014 May;16 Epub. PubMed

Surface treatment of artificial implants with hybrid nanolayers: results of antibacterial tests, leachates and scanning electron microscope analysis

A polypropylene mesh modified with poly-ε-caprolactone nanofibers in hernia repair: large animal experiment

Platelet-functionalized three-dimensional poly-ε-caprolactone fibrous scaffold prepared using centrifugal spinning for delivery of growth factors

Nanofibrous polycaprolactone scaffolds with adhered platelets stimulate proliferation of skin cells