Year 2014 Vol. 22 No 6

GENERAL AND SPECIAL SURGERY

V.I. BELOKONEV 1, J.V. PONOMAREVA 1, S.Y. PUSHKIN 2, O.N. MELENTIEVA 1, M.G. GULYAEV 1

POTENTIAL PREDICTORS AND MORPHOLOGICAL ASPECTS OF SEROMA DEVELOPMENT AFTER PLASTIC SURGERY OF THE ANTERIOR ABDOMINAL WALL HERNIA

SBEE HPE Samara State Medical University1,
SBME Samara Regional Clinical Hospital named after M.I. Kalinin2,
The Russian Federation

Objectives. To determine potential predictors of seroma formation on the basis of pathomorphological picture.
Methods. The analysis of indicators of the level of C-C motifligand 2 (CCL2) has been conducted by ELISA in the serum and exudates of 68 patients prior surgery and after it on the 4th, 10th-12th day in case the surgical removal of ventral hernia W3, W4 the cutaneous and adipose flap was dissected with the plastic gates by polypropylene endoprosthesis. In patients with advanced seroma a morphological study of its walls, contents, and adjacent tissues was carried out.
Results. In patients with normal postoperative period after hernioplasty the elevation of CCL2 values in the serum and exudate was observed and their reduction has occured up to 10th-12th days. Similar changes were revealed in the group of patients with planned surgical pathology. Patients who subsequently seroma developed to the 4th day the level of CCL2 was 3 folds higher regarding to the control groups without any tendency to reduce (p<0,05). Morphological analysis revealed signs of both acute and chronic inflammation in the tissues depending on the terms of seroma existence.
Conclusion. The injured cells of the adipose tissue and macrophages migrating to the inflammatory focus are considered to be the source of the chemokine CCL2, supporting an exudative inflammation. From this point of view the determination of CCL2 level in the blood serum and/or discharge from the drainage after hernioplasty accompanied by immobilization of subcutaneous and adipose flap over a large area can serve as factors predicting seroma formation.

Keywords: ventral hernia, surgical treatment, seroma, subcutaneous and adipose flap, chemokine CCL2, polypropylene endoprosthesis
p. 665-670 of the original issue
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Address for correspondence:
443079, Rossiyskaya Federatsiya, g. Samara, ul. Gagarina, d. 20, Institut eksperimentalnoy meditsinyi i biotehnologiy (IEMB) GBOU VPO Samarskiy gosudarstvennyiy meditsinskiy universitet,
tel. office: 7 846 260-09-42,
e-mail: jvponomareva@mail.ru,
Ponomareva Juliya Vyacheslavovna
Information about the authors:
Belokonev V.I. MD, professor, Honored Doctor of Russia, a head of the surgical diseases chair 2 of SBEE HPE Samara State Medical University.
Ponomareva J.V. PhD, senior researcher of Institute of Experimental Medicine and Biotechnologies of SBEE HPE Samara State Medical University.
Pushkin S.Y. MD, Deputy Chief on Surgery of SBME Samara Regional Clinical Hospital named after M.I. Kalinin.
Melentieva O.N. PhD, an associate professor of the surgical diseases chair 2 of SBEE HPE Samara State Medical University.
Gulyaev M.G. A post-graduate student of the surgical diseases chair 2 of SBEE HPE Samara State Medical University.
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