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Serin M, Altinel D, Leblebici C, Biltekin B, Huseyinbas O, Kurt Yazar S, Irmak F, Sonmez A, Bayramicli M. Subdermal nitrous oxide delivery increases skin microcirculation and random flap survival in rats. J Plast Surg Hand Surg 2018; 53:37-44. [PMID: 30371138 DOI: 10.1080/2000656x.2018.1531013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Random skin flaps are essential tools in reconstructive surgery. In this study, we investigated the effect of subdermal nitrous oxide (N2O) application on random flap survival. In this experimental study, we used 21 female rats in three groups. In the N2O and air groups, gases were administrated under the proposed dorsal flap areas daily for seven days. Following the treatment period, flaps were raised and inserted back into their place from the dorsal skin. In the control group, the flaps were elevated and inserted back to their place without any pretreatment. Calculation of necrotic flap areas, histological examination and microangiography was performed to evaluate the results 7 days after the flap surgery. The average of necrotic flap area in the N2O, air and control group was 13.45%, 37.67% and 46.43%, respectively. (N2O vs air p = .044; N2O vs control p = .003). The average number of capillary formations identified in the histological analysis was 7.0 ± 1.58, 3.75 ± 2.36 and 4.4 ± 0.54 in the N2O, air and control group, respectively. (N2O vs air p = .017; N2O vs control p = .037). The average number of capillary structures identified in the angiography images were 6.3 ± 1.52, 1.6 ± 1.15 and 1.3 ± 0.57 in the N2O, air and control group, respectively. (N2O vs air p = .04; N2O vs control p = .02). We conclude that subdermal N2O application increases random flap survival through an increase in the skin microcirculation and could be promising for future clinical applications.
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Affiliation(s)
- Merdan Serin
- a Department of Plastic and Reconstructive Surgery , Istanbul Training and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Dincer Altinel
- a Department of Plastic and Reconstructive Surgery , Istanbul Training and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Cem Leblebici
- b Department of Pathology , Istanbul Training and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Burcu Biltekin
- c Department of Histology and Embryology , Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Onder Huseyinbas
- d Animal Research Laboratory , Istanbul Bezmialem University Medical School , Istanbul , Turkey
| | - Sevgi Kurt Yazar
- a Department of Plastic and Reconstructive Surgery , Istanbul Training and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Fatih Irmak
- e Department of Plastic and Reconstructive Surgery , Istanbul Sisli Etfal Training and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Ahmet Sonmez
- f Private practice in Plastic and Reconstructive Surgery , Istanbul , Turkey
| | - Mehmet Bayramicli
- g Department of Plastic and Reconstructive Surgery , Marmara University School of Medicine , Istanbul , Turkey
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Attenuation of Ischemia-Reperfusion Injury and Improvement of Survival in Recipients of Steatotic Rat Livers Using CD47 Monoclonal Antibody. Transplantation 2017; 100:1480-9. [PMID: 27331362 DOI: 10.1097/tp.0000000000001186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the efficacy of orthotopic liver transplantation in the treatment of end-stage liver diseases, its therapeutic utility is severely limited by the availability of donor organs. The ability to rehabilitate marginal organs, such as steatotic allografts, has the potential to address some of the supply limitations of available organs for transplantation. Steatotic livers are more susceptible to ischemia-reperfusion injury (IRI), which is exacerbated by the thrombospondin-1/CD47 pathway through inhibition of nitric oxide signaling. We postulated that CD47 blockade with a monoclonal antibody specific to CD47, clone 400 (CD47mAb400) may reduce the extent of IRI in steatotic liver allografts. METHODS Orthotopic liver transplantation was performed using steatotic liver grafts from Zucker rats transplanted into lean recipients. Control IgG or the CD47mAb400 was administered to the donor livers at procurement. Serum transaminases, histological changes, and animal survival were assessed. Hepatocellular damage, oxidative and nitrosative stress, and inflammation were also quantified. RESULTS Administration of CD47mAb400 to donor livers increased recipient survival and resulted in significant reduction of serum transaminases, bilirubin, triphosphate nick-end labeling staining, caspase-3 activity, oxidative and nitrosative stresses, and proinflammatory cytokine expression of TNF-α, IL-6 and IL-1β. CONCLUSIONS We conclude that administration of CD47mAb400 to donor grafts may reduce IRI through CD47 blockade to result in improved function of steatotic liver allografts and increased survival of recipients and represent a novel strategy to allow the use of livers with higher levels of steatosis.
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Ghanbarzadeh K, Tabatabaie OR, Salehifar E, Amanlou M, Khorasani G. Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats. Plast Surg (Oakv) 2016; 24:99-102. [PMID: 27441193 DOI: 10.4172/plastic-surgery.1000962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. OBJECTIVE To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. METHODS The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. RESULTS BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). CONCLUSIONS BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
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Affiliation(s)
- Kourosh Ghanbarzadeh
- Division of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran, Iran
| | | | - Ebrahim Salehifar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Massoud Amanlou
- Department of Medical Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasemali Khorasani
- Division of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran, Iran
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Guye ML, Motamed C, Chemam S, Leymarie N, Suria S, Weil G. Remote peripheral tissue oxygenation does not predict postoperative free flap complications in complex head and neck cancer surgery: A prospective cohort study. Anaesth Crit Care Pain Med 2016; 36:27-31. [PMID: 27320053 DOI: 10.1016/j.accpm.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients undergoing free flap reconstruction after head and neck cancer may develop free flap complications. In the perioperative period, haemoglobin content and oxygen tissue saturation (StO2) measured directly on the free flap reflect peripheral tissue oxygenation. However, in this type of surgery, StO2 cannot always be applied directly or proximate to the free flap. The aim of this study was to assess the possible value of StO2 measured at the thenar eminence and other 24hour perioperative factors on free flap complications. METHODS Inclusion criteria corresponded to patients with head and neck cancer with free flap surgery in whom direct StO2 could not be monitored on the flap nor in its peripheral area. Patient characteristics and intraoperative data, such as haemoglobin and fluid management, were prospectively collected. StO2 was measured remotely on the thenar eminence. Data were collected for 24hours and free flap complications were recorded for up to 15days after surgery. Patients were thereafter classified into two groups: with or without free flap complications and the data were compared in consequence. RESULTS Forty consecutive patients were prospectively included. Ten patients had postoperative free flap complications and were compared to the 30 other patients without complications. The haemoglobin level at the reperfusion of the flap: (AUC 0.80 [0.65-0.91], threshold 9.9g/dL, P<0.001) and body mass index [BMI] (AUC 0.80 [0.64-0.72], threshold 24.5kg/m2, P<0.01) were significantly related to complications. CONCLUSION In head and neck complex oncologic reconstructive surgery, haemoglobin and BMI were the most sensitive tools for predicting postoperative free flap complications, while thenar eminence StO2 was not.
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Affiliation(s)
- Marie-Laurence Guye
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Cyrus Motamed
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - Sarah Chemam
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Nicolas Leymarie
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Stéphanie Suria
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Grégoire Weil
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
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Ghanbarzadeh K, Tabatabaie OR, Salehifar E, Amanlou M, Khorasani G. Effect of botulinum toxin a and nitroglycerin on random skin flap survival in rats. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. Objective To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. Methods The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. Results BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). Conclusions BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
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Affiliation(s)
| | | | - Ebrahim Salehifar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari
| | - Massoud Amanlou
- Department of Medical Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasemali Khorasani
- Division of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex
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Xiao ZY, Banan B, Jia J, Manning PT, Hiebsch RR, Gunasekaran M, Upadhya GA, Frazier WA, Mohanakumar T, Lin Y, Chapman WC. CD47 blockade reduces ischemia/reperfusion injury and improves survival in a rat liver transplantation model. Liver Transpl 2015; 21:468-477. [PMID: 25482981 PMCID: PMC4601606 DOI: 10.1002/lt.24059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/30/2014] [Indexed: 12/17/2022]
Abstract
Orthotopic liver transplantation (OLT) remains the standard treatment option for nonresponsive liver failure. Because ischemia/reperfusion injury (IRI) is an important impediment to the success of OLT, new therapeutic strategies are needed to reduce IRI. We investigated whether blocking the CD47/thrombospondin-1 inhibitory action on nitric oxide signaling with a monoclonal antibody specific to CD47 (CD47mAb400) would reduce IRI in liver grafts. Syngeneic OLT was performed with Lewis rats. Control immunoglobulin G or CD47mAb400 was administered to the donor organ at procurement or to both the organ and the recipient at the time of transplant. Serum transaminases, histological changes of the liver, and animal survival were assessed. Oxidative stress, inflammatory responses, and hepatocellular damage were also quantified. A significant survival benefit was not achieved when CD47mAb400 was administered to the donor alone. However, CD47mAb400 administration to both the donor and the recipient increased animal survival afterward. The CD47mAb400-treated group showed lower serum transaminases, bilirubin, oxidative stress, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling staining, caspase-3 activity, and proinflammatory cytokine expression of tumor necrosis factor α, interleukin-1β, and interleukin-6. Thus, CD47 blockade with CD47mAb400 administered both to the donor and the recipient reduced liver graft IRI in a rat liver transplantation model. This may translate to decreased liver dysfunction and increased survival of liver transplant recipients.
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Affiliation(s)
- Zhen-Yu Xiao
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Babak Banan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jianluo Jia
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | | | - Muthukumar Gunasekaran
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Gundumi A. Upadhya
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - William A. Frazier
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO
,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO
| | - Thalachallour Mohanakumar
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - William C. Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Yang M, Angel MF, Pang Y, Angel JJ, Wang Z, Neumeister MW, Wetter N, Zhang F. Expression of inducible nitric oxide synthase in muscle flaps treated with ischemic postconditioning. Hand (N Y) 2012; 7:297-302. [PMID: 23997736 PMCID: PMC3418363 DOI: 10.1007/s11552-012-9423-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVE Preconditioning has been considered promising for the treatment of ischemic flaps. In this study, the therapeutic effect of postconditioning was compared with that of preconditioning during ischemia/reperfusion (I/R) injury, and a role of inducible nitric oxide synthase (iNOS) in postconditioning treatment was also explored. METHODS Sixty rats were randomly divided into four groups with 15 rats in each group. Ischemic injury was induced in a rat's gracilis muscle flap model. Preconditioning and postconditioning were performed respectively on the flaps in the pre-con group and the post-con group. No treatment was given to the flaps in the control group, and flaps without I/R injury were used as a sham control. Muscle viability ratio, histology, and gene expression of iNOS were examined at different time intervals (3, 12, and 18 h). RESULTS A significantly higher survival ratio was observed in both the pre-con group (78.98 ± 3.39, 62.74 ± 3.7, and 54.42 ± 4.45 %) and the post-con group (77.42 ± 4.14, 59.74 ± 6.67, and 49.52 ± 4.13 %) than the control group (45.22 ± 3.69, 42.44 ± 3.76, and 33.2 ± 3.29 %) at 3, 12, and 18 h postoperatively (P < 0.05). There was no statistical difference between the pre-con group and the post-con group (P > 0.05). Histological examination showed delayed and attenuated tissue damage in both the pre-con group and the post-con group when compared to that of the control group. A higher expression of iNOS was observed in both the pre-con group and the post-con group than the control group and the sham group (P < 0.05). CONCLUSIONS Significant improvement of flap survival could be achieved by both preconditioning and postconditioning treatments; however, better protection could be provided by preconditioning. The higher expression of iNOS may play an important role in the therapeutic effect of postconditioning during I/R injury.
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Affiliation(s)
- Mei Yang
- Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Michael F. Angel
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 USA
| | - Yi Pang
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 USA
| | - John J. Angel
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 USA
| | - Zhe Wang
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 USA
| | - Michael W. Neumeister
- Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Nathan Wetter
- Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Feng Zhang
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 USA
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Acute and Sustained Effects of Vascular Endothelial Growth Factor on Survival of Flaps and Skin Grafts. Ann Plast Surg 2011; 66:581-2. [DOI: 10.1097/sap.0b013e3182057376] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maxhimer JB, Shih HB, Isenberg JS, Miller TW, Roberts DD. Thrombospondin-1/CD47 blockade following ischemia-reperfusion injury is tissue protective. Plast Reconstr Surg 2009; 124:1880-1889. [PMID: 19952644 PMCID: PMC2794041 DOI: 10.1097/prs.0b013e3181bceec3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Nitric oxide has prosurvival effects that can limit ischemia-reperfusion injuries. However, the matrix glycoprotein thrombospondin-1 is induced following ischemia-reperfusion injury and limits nitric oxide signaling by engaging its cell surface receptor CD47. In this article, the authors examine whether postinjury blocking of this inhibitory signal can protect from ischemia-reperfusion injury in a rat flap model. METHODS A total of 40 tissue flaps were created in rats based solely on the deep inferior epigastric vessels. Microvascular clamps were used to create 45 minutes of ischemia time to the flaps. The flaps were then treated using a monoclonal antibody to CD47 or an isotype-matched control immunoglobulin G1 5 or 30 minutes after clamp removal. Twenty-four or 72 hours postoperatively, the necrotic area of the flap was determined, and serum, deep inferior epigastric vessels, and flaps were harvested for analysis from five rats in each respective group. RESULTS Treatment with a CD47 antibody 5 minutes after reperfusion significantly reduces flap necrosis compared with immunoglobulin G1 control (9 percent versus 43 percent; p < 0.01). The protective effect is even more dramatic when treatment is delayed until 30 minutes after reperfusion (10 percent versus 88 percent for control; p < 0.01). Markers of neutrophil and endothelial cell activation along with total leukocytes are reduced in CD47 antibody-treated flaps, as are tissue malondialdehyde levels. Levels of cyclic guanosine monophosphate are elevated 72 hours postoperatively in the CD47 antibody-treated deep inferior epigastric vessels versus the control flaps. CONCLUSIONS Therapies targeting the thrombospondin-1 receptor CD47 offer potential for increasing tissue survival in ischemia-reperfusion injuries. The ability to protect when given after ischemia-reperfusion injury enables a broader clinical applicability.
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Affiliation(s)
- Justin B Maxhimer
- Bethesda and Baltimore, Md.; and Pittsburgh, Pa. From the Laboratory of Pathology, National Cancer Institute, National Institutes of Health; the Department of Surgery, The Johns Hopkins Medical Institutions; the Howard Hughes Medical Institute-National Institutes of Health Research Scholar Program; and the Division of Pulmonary, Allergy, and Critical Care Medicine and Vascular Medicine Institute, University of Pittsburgh School of Medicine
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The Effects of the Pentoxifylline on Survival of the Skin Flaps in Streptozotocin-Diabetic Rats. Ann Plast Surg 2009; 62:446-50. [DOI: 10.1097/sap.0b013e31817f01c7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nitric oxide in flow-through venous flaps and effects of L-arginine and nitro-L-arginine methyl ester (L-NAME) on nitric oxide and flap survival in rabbits. Ann Plast Surg 2008; 59:550-7. [PMID: 17992151 DOI: 10.1097/01.sap.0000258931.80194.b7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECT Venous flaps are relatively recent practices in plastic surgery, and their life mechanisms are not known exactly. Partial necroses frequently occur in these flaps; therefore, their survival should be enhanced. Nitric oxide (NO) is an endogenous compound which has recently been dwelt upon frequently in flap pathophysiology, and its effect on viability in conventional flaps has been demonstrated. However, its role in venous flaps is unknown. The purpose of this study is to determine possible changes in the NO level in venous flaps and to investigate the possible effects of NO synthesis precursor and inhibitor on the venous flap NO level and flap survival. MATERIAL AND METHODS Thirty white male rabbits of New Zealand type, aged 6 months, were divided into 3 groups as control (n = 10), L-arginine (n = 10), and nitro-L-arginine methyl ester (L-NAME) (n = 10). Blood and tissue samples were taken from one ear of 10 rabbits in the control group for the determination of NO basal levels 2 weeks before flap practice. The 3-x-5-cm flow-through venous flaps, which are sitting on the anterior branch of the central vein, were elevated on each ear of 10 rabbits in all groups. After flaps were sutured to their beds, 2 mL/d saline, 1 g/kg/d L-arginine (NO synthesis precursor), and 50 mg/kg/d L-NAME (NO synthesis inhibitor) were administered intraperitoneally in control, L-arginine, and L-NAME groups, respectively, for 3 days. At the 24th postoperative hour, blood and tissue samples were taken from all animals for biochemical analyses. At day 7, flap survivals were assessed. RESULTS Mean NO levels in the blood following the flap elevation (129 +/- 76 micromol/mg protein) increased in comparison with basal levels (59 +/- 44 micromol/mg protein) (P < 0.06); however, the tissue level remained unchanged. NO levels in the blood in the L-arginine and L-NAME groups were alike compared with the control group. The tissue NO level in L-NAME group (0.08 +/- 0.03 micromol/mg protein) decreased significantly compared to the control group (0.46 +/- 0.36 micromol/mg protein) (P < 0.001). Mean flap survival in the L-arginine group (95% +/- 6) increased according to the control group (61% +/- 14) (P < 0.001), whereas it did not change in the L-NAME group (55% +/- 13). CONCLUSION In our model of venous flap, NO level in the blood increased, while it did not change in the tissue; L-arginine significantly enhanced flap viability without affecting NO level. Additionally, L-NAME decreased NO level, but it did not affect flap survival. In light of these findings, NO increases in venous flaps; the change in its level does not affect flap survival, though. However, L-arginine enhances venous flap survival if not by virtue of NO.
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Blockade of thrombospondin-1-CD47 interactions prevents necrosis of full thickness skin grafts. Ann Surg 2008; 247:180-90. [PMID: 18156939 DOI: 10.1097/sla.0b013e31815685dc] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Skin graft survival and healing requires rapid restoration of blood flow to the avascular graft. Failure or delay in the process of graft vascularization is a significant source of morbidity and mortality. One of the primary regulators of blood flow and vessel growth is nitric oxide (NO). The secreted protein thrombospondin-1 (TSP1) limits NO-stimulated blood flow and growth and composite tissue survival to ischemia. We herein demonstrate a role for TSP1 in regulating full thickness skin graft (FTSG) survival. METHODS AND RESULTS FTSG consistently fail in wild type C57BL/6 mice but survive in mice lacking TSP1 or its receptor CD47. Ablation of the TSP1 receptor CD36, however, did not improve FTSG survival. Remarkably, wild type FTSG survived on TSP1 null or CD47 null mice, indicating that TSP1 expression in the wound bed is the primary determinant of graft survival. FTSG survival in wild type mice could be moderately improved by increasing NO flux, but graft survival was increased significantly through antibody blocking of TSP1 binding to CD47 or antisense morpholino oligonucleotide suppression of CD47. CONCLUSIONS TSP1 through CD47 limits skin graft survival. Blocking TSP1 binding or suppressing CD47 expression drastically increases graft survival. The therapeutic applications of this approach could include burn patients and the broader group of people requiring grafts or tissue flaps for closure and reconstruction of complex wounds of diverse etiologies.
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Gribbe Ö, Gustafsson LE, Wiklund NP. Transdermally administered nitric oxide by application of acidified nitrite increases blood flow in rat epigastric island skin flaps. Eur J Pharmacol 2008; 578:51-6. [DOI: 10.1016/j.ejphar.2007.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 09/09/2007] [Accepted: 09/18/2007] [Indexed: 11/26/2022]
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Isenberg JS, Hyodo F, Matsumoto KI, Romeo MJ, Abu-Asab M, Tsokos M, Kuppusamy P, Wink DA, Krishna MC, Roberts DD. Thrombospondin-1 limits ischemic tissue survival by inhibiting nitric oxide-mediated vascular smooth muscle relaxation. Blood 2006; 109:1945-52. [PMID: 17082319 PMCID: PMC1801044 DOI: 10.1182/blood-2006-08-041368] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The nitric oxide (NO)/cGMP pathway, by relaxing vascular smooth muscle cells, is a major physiologic regulator of tissue perfusion. We now identify thrombospondin-1 as a potent antagonist of NO for regulating F-actin assembly and myosin light chain phosphorylation in vascular smooth muscle cells. Thrombospondin-1 prevents NO-mediated relaxation of precontracted vascular smooth muscle cells in a collagen matrix. Functional magnetic resonance imaging demonstrated that an NO-mediated increase in skeletal muscle perfusion was enhanced in thrombospondin-1-null relative to wild-type mice, implicating endogenous thrombospondin-1 as a physiologic antagonist of NO-mediated vasodilation. Using a random myocutaneous flap model for ischemic injury, tissue survival was significantly enhanced in thrombospondin-1-null mice. Improved flap survival correlated with increased recovery of oxygen levels in the ischemic tissue of thrombospondin-1-null mice as measured by electron paramagnetic resonance oximetry. These findings demonstrate an important antagonistic relation between NO/cGMP signaling and thrombospondin-1 in vascular smooth muscle cells to regulate vascular tone and tissue perfusion.
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Affiliation(s)
- Jeff S Isenberg
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1500, USA
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Van Buren G, Camp ER, Yang AD, Gray MJ, Fan F, Somcio R, Ellis LM. The role of nitric oxide in mediating tumour blood flow. Expert Opin Ther Targets 2006; 10:689-701. [PMID: 16981826 DOI: 10.1517/14728222.10.5.689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nitric oxide (NO) is a ubiquitous molecule with a myriad of physiological and pathophysiological roles. It has numerous direct and indirect effects on tumour vasculature as both a regulatory and effector molecule. NO affects tumour blood flow through its effects on tumour angiogenesis, vascular tone and vascular permeability, partly via its interaction with vascular endothelial growth factor. In this review, the authors examine the basic tenants of NO biology, the association of NO with tumour progression, and the role NO plays in mediating alterations in vascular functions in tumours.
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Affiliation(s)
- George Van Buren
- University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX 77230, USA
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Aller MA, Arias JL, Arias JI, Sánchez-Patán F, Arias J. The inflammatory response recapitulates phylogeny through trophic mechanisms to the injured tissue. Med Hypotheses 2006; 68:202-9. [PMID: 16963191 DOI: 10.1016/j.mehy.2006.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 06/16/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
The post-traumatic local acute inflammatory response is described as a succession of three functional phases of possible trophic significance: 1. Nervous or immediate (ischemia-reperfusion); 2. Immune or intermediate (infiltration by inflammatory and bacterial cells) and 3. Endocrine or late (angiogenesis with regeneration and/or cicatrization). Each of these phases emphasizes the trophic role of the mechanisms in the damaged tissue. Hence, the nervous phase is predominated by nutrition by diffusion; in the immune phase trophism is mediated by inflammatory cells and bacteria and, finally, in the endocrine phase, the blood circulation and oxidative metabolism play the most significant nutritive role. Since these trophic mechanisms are of increasing complexity, progressing from anoxia to total specialization in the use of oxygen to obtain usable energy, it could be speculated that they represent the successive reappearance of the stages that take place during the evolution of life on Earth, from ancient times without oxygen. In this sense, the inflammatory response could recapitulate phylogeny through the successive expression of pathophysiologic mechanisms that have a trophic meaning to the injured tissue.
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Affiliation(s)
- M A Aller
- Surgery Department, School of Medicine, Complutense University of Madrid, Spain
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