Augmenting Myometrial Healing after Cesarean Delivery: Use of an Adjuvant Biologic Graft Placement in an Ovine Model

ABSTRACT

We sought to reduce long-term complications after cesarean delivery by improving myometrial healing. Eight sheep (three with twins) underwent cesarean delivery. Hysterotomy sites were repaired in equal parts by suture alone or suture with a juxtaposed graft (Cook Medical, Bloomington, IN). At 90 days postsurgery, scar characteristics and tensile strength testing were assessed. The mean hysterotomy closure time was on average 1 minute, 14 seconds longer for those undergoing graft placement (p = 0.36). The mean scar thickness was 3.0 ± 0.4 mm for controls versus 3.8 ± 1.2 mm for the intervention group (p = 0.047). Tensile strength testing did not demonstrate a significant difference between groups. Histological examination of the myometrial scar showed no significant differences in inflammatory reaction or endometrial inclusions; however, neoangiogenesis was significantly enhanced. Myometrial repair incorporating a graft increased scar thickness and neoangiogenesis. This methodology did not incite adenomyosis or enhance inflammation within the scar.

KEYWORDS

Cesarean delivery - graft - hysterotomy - ovine model - small intestinal submucosa

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