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Müller-Seubert W, Ostermaier P, Horch RE, Distel L, Frey B, Erber R, Arkudas A. The Influence of Different Irradiation Regimens on Inflammation and Vascularization in a Random-Pattern Flap Model. J Pers Med 2023; 13:1514. [PMID: 37888125 PMCID: PMC10608321 DOI: 10.3390/jpm13101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Irradiation plays an important role in the oncological treatment of various tumor entities. The aim of the study was to investigate the influence of different irradiation regimens on random-pattern flaps at the molecular and histopathological levels. METHODS Twenty-five rats underwent harvesting of bilateral random-pattern fasciocutaneous flaps. The right flaps received irradiation, while the left flaps served as non-irradiated intraindividual controls. Five rats served as a non-irradiated control group. Four different irradiation regimens with give rats each were tested: 20 Gy postoperatively, 3 × 12 Gy postoperatively, 20 Gy preoperatively, and 3 × 12 Gy preoperatively. Two weeks after surgery, HE staining and immunohistochemical staining for CD68 and ERG, as well as PCR analysis to detect Interleukin 6, HIF-1α, and VEGF, were performed. RESULTS A postoperative cumulative higher dose of irradiation appeared to result in an increase in necrosis, especially in the superficial layers of the flap compared to preoperative or single-stage irradiation. In addition, we observed increased expression of VEGF and HIF-1α in all irradiation groups. CONCLUSION Even though no statistically significant differences were found between the different groups, there was a tendency for fractional postoperative irradiation with a higher total dose to have a more harmful effect compared to preoperative or single-dose irradiation.
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Affiliation(s)
- Wibke Müller-Seubert
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany; (P.O.); (R.E.H.)
| | - Patrick Ostermaier
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany; (P.O.); (R.E.H.)
| | - Raymund E. Horch
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany; (P.O.); (R.E.H.)
| | - Luitpold Distel
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany;
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany;
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany;
| | - Andreas Arkudas
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany; (P.O.); (R.E.H.)
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Müller-Seubert W, Ostermaier P, Horch RE, Distel L, Frey B, Cai A, Arkudas A. Intra- and Early Postoperative Evaluation of Malperfused Areas in an Irradiated Random Pattern Skin Flap Model Using Indocyanine Green Angiography and Near-Infrared Reflectance-Based Imaging and Infrared Thermography. J Pers Med 2022; 12:jpm12020237. [PMID: 35207725 PMCID: PMC8880010 DOI: 10.3390/jpm12020237] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Assessment of tissue perfusion after irradiation of random pattern flaps still remains a challenge. Methods: Twenty-five rats received harvesting of bilateral random pattern fasciocutaneous flaps. Group 1 served as nonirradiated control group. The right flaps of the groups 2–5 were irradiated with 20 Gy postoperatively (group 2), 3 × 12 Gy postoperatively (group 3), 20 Gy preoperatively (group 4) and 3 × 12 Gy preoperatively (group 5). Imaging with infrared thermography, indocyanine green angiography and near-infrared reflectance-based imaging were performed to detect necrotic areas of the flaps. Results: Analysis of the percentage of the necrotic area of the irradiated flaps showed a statistically significant increase from day 1 to 14 only in group 5 (p < 0.05). Indocyanine green angiography showed no differences (p > 0.05) of the percentage of the nonperfused area between all days in group 1 and 3, but a decrease in group 2 in both the left and the right flaps. Infrared thermography and near-infrared reflectance-based imaging did not show evaluable differences. Conclusion: Indocyanine green angiography is more precise in prediction of necrotic areas in random pattern skin flaps when compared to hyperspectral imaging, thermography or clinical impression. Preoperative fractional irradiation with a lower individual dose but a higher total dose has a more negative impact on flap perfusion compared to higher single stage irradiation.
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Affiliation(s)
- Wibke Müller-Seubert
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany; (P.O.); (R.E.H.); (A.C.); (A.A.)
- Correspondence: ; Tel.: +49-9131-85-33296; Fax: +49-9131-85-39327
| | - Patrick Ostermaier
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany; (P.O.); (R.E.H.); (A.C.); (A.A.)
| | - Raymund E. Horch
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany; (P.O.); (R.E.H.); (A.C.); (A.A.)
| | - Luitpold Distel
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany;
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany;
| | - Aijia Cai
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany; (P.O.); (R.E.H.); (A.C.); (A.A.)
| | - Andreas Arkudas
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg FAU, 91054 Erlangen, Germany; (P.O.); (R.E.H.); (A.C.); (A.A.)
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Effect of Previous Irradiation on Vascular Thrombosis of Microsurgical Anastomosis: A Preclinical Study in Rats. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1073. [PMID: 27975009 PMCID: PMC5142475 DOI: 10.1097/gox.0000000000001073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 08/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of the present investigation was to compare the effect of neoadjuvant irradiation on the microvascular anastomosis in cervical bundle using an experimental model in rats. METHODS One hundred forty male Sprague-Dawley rats were allocated into 4 groups: group I, control, arterial microanastomosis; group II, control, venous microanastomosis; group III, arterial microanastomosis with previous irradiation (20 Gy); and group IV, venous microanastomosis with previous irradiation (20 Gy). Clinical parameters, technical values of anastomosis, patency, and histopathological parameters were evaluated. RESULTS Irradiated groups (III and IV) and vein anastomosis groups (II and IV) showed significantly increased technical difficulties. Group IV showed significantly reduced patency rates (7/35) when compared with the control group (0/35). Radiotherapy significantly decreased the patency rates of the vein (7/35) when compared with the artery (1/35). Groups III and IV showed significantly reduced number of endothelial cells and also showed the presence of intimal thickening and adventitial fibrosis as compared with the control group. CONCLUSION Neoadjuvant radiotherapy reduces the viability of the venous anastomosis in a preclinical rat model with a significant increase in the incidence of vein thrombosis.
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Barrera-Ochoa S, Gallardo-Calero I, Sallent A, López-Fernández A, Vergés R, Giralt J, Aguirre-Canyadell M, Velez R. New and safe experimental model of radiation-induced neurovascular histological changes for microsurgical research. Lab Anim 2016; 51:124-137. [PMID: 27357187 DOI: 10.1177/0023677216656221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim is to create a new and safe experimental model of radiation-induced neurovascular histological changes with reduced morbidity and mortality for use with experimental microsurgical techniques. Seventy-two Sprague-Dawley rats (250-300 g) were divided as follows: Group I: control group, 24 rats clinically evaluated during six weeks; Group II: evaluation of acute side-effects (two-week follow-up period), 24 irradiated (20 Gy) rats; and Group III: evaluation of subacute side-effects (six-week follow-up period), 24 irradiated (20 Gy) rats. Variables included clinical assessments, weight, vascular permeability (arterial and venous), mortality and histological studies. No significant differences were observed between groups with respect to the variables studied. Significant differences were observed between groups I vs II-III regarding survival rates and histological changes to arteries, veins and nerves. Rat body weights showed progressive increases in all groups, and the mortality rate of the present model is 10.4% compared with 30-40% in the previous models. In conclusion, the designed model induces selective changes by radiotherapy in the neurovascular bundle without histological changes affecting the surrounding tissues. This model allows therapeutic experimental studies to be conducted, including the viability of microvascular and microneural sutures post radiotherapy in the cervical neurovascular bundle.
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Affiliation(s)
- Sergi Barrera-Ochoa
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,2 Hand and Microsurgery Unit, ICATME-Hospital Universitari Quiron-Dexeus, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Irene Gallardo-Calero
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Andrea Sallent
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Alba López-Fernández
- 3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ramona Vergés
- 4 Radiotherapy Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Jordi Giralt
- 4 Radiotherapy Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Marius Aguirre-Canyadell
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Roberto Velez
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
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Radiation and Microcirculation Models. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Simşek T, Eroğlu L. Bipedicled free rat epigastric flap as an experimental model. Ann Plast Surg 2006; 57:241-2. [PMID: 16862016 DOI: 10.1097/01.sap.0000226945.50743.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnson LB, Adawi D, Agren MS, Jorgensen LN, Wittgren L, Mattsson S, Blomquist P, Gottrup F, Jeppsson B. Combination of Pre-Operative Radiotherapy and Surgery Suppresses Local Accumulation of Collagen and TGF-β1 in Rats. J Surg Res 2006; 133:136-42. [PMID: 16458927 DOI: 10.1016/j.jss.2005.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 11/02/2005] [Accepted: 12/15/2005] [Indexed: 12/31/2022]
Abstract
BACKGROUND The systemic and local tissue repair responses of radiation in combination with surgery are still unclear. We have studied the effect of fractionated pre-operative radiotherapy with or without subsequent laparotomy on collagen accumulation using a rodent model. MATERIALS AND METHODS Thirty-two male Sprague-Dawley rats were divided into four groups (eight rats per group): 1) sham radiation and sham laparotomy (control); 2) sham radiation and laparotomy; 3) radiation and sham laparotomy; and 4) radiation followed by laparotomy. Expanded polytetrafluoroethylene (ePTFE) tubes were implanted subcutaneously in the abdominal wall in the radiotherapy field and on the back outside the radiotherapy field day 0. The abdomen (3 cm x 4 cm) was irradiated day 3 (10 Gy) and again day 7 (10 Gy). On day 10, implants were extirpated, laparotomy undertaken in groups 2 and 4 and new ePTFE tubes implanted subcutaneously. The second implants were extirpated on day 20. Implants were analyzed for hydroxyproline, total protein and transforming growth factor-beta1 (TGF-beta1) levels. RESULTS On day 10, hydroxyproline (P < 0.05) and TGF-beta1 (P < 0.001) were lower in ePTFE tubes in irradiated compared with non-irradiated rats. On day 20, the abdominal ePTFE hydroxyproline remained low (P < 0.001) in animals subjected to laparotomy and pre-operative irradiation while hydroxyproline levels of rats subjected to irradiation only were similar to controls. The effects of radiation on hydroxyproline were confined to the irradiated abdominal area. There was a positive correlation between hydroxyproline and TGF-beta1 levels in the abdominal wall implant day 20 (r = 0.53, P < 0.005). CONCLUSION A clinically relevant fractionated radiation scheme reduced subcutaneous collagen accumulation pre-operatively and profoundly within the radiation field post-operatively after laparotomy, possibly because of lowered TGF-beta1 levels.
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Affiliation(s)
- Louis B Johnson
- Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.
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Aydin A, Ozden BC, Mezdeği A, Kurul S, Meral R, Solakoğlu S. Effects of amifostine on healing of microvascular anastomoses, flap survival, and nerve regeneration with preoperative or postoperative irradiation. Microsurgery 2004; 24:392-9. [PMID: 15378586 DOI: 10.1002/micr.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Amifostine is an organic thiophosphate compound, which has both cytoprotective and radioprotective effects. An experimental study was undertaken to investigate the effects of its use on reconstructive surgery in cancer treatment. One hundred and twenty guinea pigs were divided into three equal groups to investigate flap survival and healing, patency of microvascular anastomoses, and nerve regeneration, respectively. The groups were subdivided in such a way that they were given either preoperative or postoperative radiotherapy, with or without amifostine treatment. Macroscopic and planimetric examination, light and electron microscopy, and histomorphometric analyses were performed to evaluate flap survival and healing, patency of arterial anastomoses, and nerve regeneration. Although flap survival rates were not affected, significantly better flap healing was observed in the postoperative radiotherapy subgroup with amifostine treatment. However, amifostine treatment did not result in a statistically significant difference in terms of anastomotic patency and nerve regeneration with either preoperative or postoperative radiotherapy.
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Affiliation(s)
- Atakan Aydin
- Division of Hand Surgery, Department of Plastic and Reconstructive Surgery, Istanbul Medical Faculty, Istanbul, Turkey.
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