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High cut-off microdialysis catheters to clinically investigate cytokine changes following flap transfer. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
‘Choke vessels’ are thought to dilate in the first 72 h when blood flow to an area is disrupted. This study used ‘high cut-off’ microdialysis catheters in clinical research to investigate factors mediating circulatory change within free flaps.
Methods
Six patients undergoing DIEP flap breast reconstruction each had three ‘high cut-off’ microdialysis catheters, with a membrane modification allowing molecules as large as 100 kDa to pass, inserted into Hartrampf zones 1, 2 and 4 to assess multiple vascular territories. Microdialysis continued for 72 h post-operatively. Samples were analysed for interleukin-6 (IL-6), tumour necrosis factor alpha (TNFα) and fibroblast growth factor basic (FGFβ).
Results
Three hundred and twenty-four samples were analysed for IL-6, FGFβ and TNFα totalling 915 analyses. IL-6 showed an increasing trend until 36 h post-operatively before remaining relatively constant. Overall, there was an increase (p < 0.001) over the time period from 4 to 72 h, fitting a linear trend. TNFα had a peak around 20–24 h before a gradual decrease. There was a significant linear time trend (p = 0.029) between 4 and 76 h, decreasing over the time period. FGFβ concentrations did not appear to have any overall difference in concentration with time. The concentration however appeared to oscillate about a horizontal trend line. There were no differences between the DIEP zones in concentrations of cytokines collected.
Conclusion
This study uses high-cut off microdialysis catheters to evaluate changes in cytokines, and requires further research to be undertaken to add to our knowledge of choke vessels and flap physiology.
Level of evidence:
Level IV, diagnostic study.
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Wang H, Hong S, Lu S, Wu T, Chai Y, Wen G. Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps: A Mechanism Study and Clinical Application. Ann Plast Surg 2021; 86:89-95. [PMID: 32568753 DOI: 10.1097/sap.0000000000002419] [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: 11/25/2022]
Abstract
BACKGROUND The arterialized venous flap (AVF) is appropriate as a flap for hand and foot resurfacing meet the aesthetic demands in the same time. However, the inconsistency of survival rate limited its popularization in clinical settings. The purpose of this study was to investigate the role played by the caliber and location of the artery. METHODS Arterialized venous flaps were designed on the abdomen of New Zealand rabbits, and the animals were randomized into 3 groups and 2 groups in experiment 1 and 2, respectively. In experiment 1, the artery flow was restricted with vascular staplers of different calibers. In experiment 2, the artery was anastomosed with the afferent vein in the center or at the margin of the flap. Blood perfusion state, water content, epidermal metabolite levels, and flap survival status were observed in both experiments. Furthermore, outcomes of 12 patients received AVF to resurface soft tissue defects in the digits, hands, and feet between January 2016 and February 2018 were analyzed. RESULTS In experiment 1, compared with the control group, groups with restricted artery showed poor results regarding blood perfusion state, water content, epidermal metabolite levels, and flap survival status. In experiment 2, group with the afferent vein in the center of the flap showed better results mentioned previously. All the flaps survived uneventfully in this study. Two flaps partially failed (20% of the flap area) because of insufficient perfusion. Generally, larger caliber and center-located vein helped the survival of AVF. CONCLUSIONS Experimental findings suggested that increased arterial perfusion and center-located vein are beneficial for the survival of AVF. Clinical series proved the findings previously. The problem of inconsistency of AVF can be partially solved by increasing arterial perfusion and dissecting afferent vein into the center of flap, and still, further studies are needed to shed light on the mechanism behind.
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Affiliation(s)
- Hongshu Wang
- From the Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Xi S, Cheng S, Meng F, Xu B, He Y, Mei J, Tang M. Effects of arterial blood supply and venous return on multi-territory perforator flap survival. J Plast Surg Hand Surg 2020; 54:187-193. [PMID: 32238087 DOI: 10.1080/2000656x.2020.1746665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to design arterial ischemic and venous congested areas on the same multi-territory perforator flap, assessing the effects of arterial blood supply and venous return on flap survival. Totally 68 rats were randomly divided into the experimental (Exp) and control (Con) groups. In the Exp group, flaps were based on left superficial epigastric artery and right superficial epigastric vein. In the Con group, flaps were based on the left superficial epigastric artery and vein. Immediate postoperative ink-gelatin angiography, epidermal metabolite levels detection, tissue edema measurement, survival rate evaluation in half of the flaps and average microvessel density assessment were performed. Blood in the Exp group flowed through most angiosomes, but only flowed around pedicled vessels in the Con group; metabolite levels of left halves in the Con and Exp groups were comparable with those of right halves. Angiosomes with high water contents occurred in the Exp group. Survival rates of left halves in the Con and Exp groups were higher than those of right halves, and more microvessels were found in the left ventral areas of both groups compared with the right ventral area in the Exp group. These findings revealed that on the same multi-territory perforator flap, arterial blood supply, affected by venous return, is a prerequisite for flap survival.
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Affiliation(s)
- Shanshan Xi
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou, China
| | - Sheng Cheng
- Department of Human Anatomy, Wenzhou Medical University School of Basic Medical Sciences, Wenzhou, China
| | - Fangmin Meng
- Department of Human Anatomy, Wenzhou Medical University School of Basic Medical Sciences, Wenzhou, China
| | - Benke Xu
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou, China
| | - Yaozhi He
- Department of Human Anatomy, Wenzhou Medical University School of Basic Medical Sciences, Wenzhou, China
| | - Jin Mei
- Department of Human Anatomy, Wenzhou Medical University School of Basic Medical Sciences, Wenzhou, China
| | - Maolin Tang
- Department of Human Anatomy, Wenzhou Medical University School of Basic Medical Sciences, Wenzhou, China
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Li X, Chen M, Jiang Z, Liu Y, Lu L, Gong X. Visualized identification of the maximal surgical delay effect in a rat flap model. Wound Repair Regen 2018; 27:39-48. [PMID: 30338888 DOI: 10.1111/wrr.12680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 08/23/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
Currently, experimental evidence suggests that the surgical delay can increase flap survival area, but its effect may decrease if the optimal delay period is missed. The aim of this study is to establish a sensitive and objective modality based on the visualized and individualized infrared thermography for identifying the maximal surgical delay effect. A rectangular three-angiosome flap was designed on the unilateral dorsum of the rat. Ninety-six rats were randomly divided into six groups according to the various delay time. Both the relative temperature and the relative temperature ratio were measured by the infrared thermography. Arterial density, number of vessels >0.1 mm in diameter, microvessel density, VEGF concentration, and flap viability were measured. Receiving operating characteristic curve with the highest Youden-Index was used to detect and identify an optimal cutoff point of the relative temperature ratio in the maximal surgical delay effect. The criteria for identifying the flap maximum delay effect based on the infrared thermography included the surface of the postdelayed flaps presented white color (higher temperature) instead of the red and white pattern of the normal skin and the optimal cutoff point of the relative temperature ratio was ≥1.17 with a sensitivity of 84.6% and a specificity of 77.3%. Instead, the sensitivity and specificity of the conventional method based on the delay time were 38.5 and 90.9%, respectively. Infrared thermal imaging can accurately identify the maximum delay effect when combined with the relative temperature ratio.
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Affiliation(s)
- Xiucun Li
- Department of Hand Surgery, Foot and Ankle Surgery, The Second Hospital of Shandong University, Shandong University, Jinan, Shandong, China.,Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Miao Chen
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Zhenmin Jiang
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Yang Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin, China
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Weng W, Zhang F, Zhao B, Wu Z, Gao W, Li Z, Yan H. The complicated role of venous drainage on the survival of arterialized venous flaps. Oncotarget 2017; 8:16414-16420. [PMID: 28145882 PMCID: PMC5369972 DOI: 10.18632/oncotarget.14845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022] Open
Abstract
The arterialized venous flap (AVF) has been gradually popularized in clinical settings; however, its survival is still inconsistent and the role of venous drainage remains elusive. In this study, we aimed to investigate the role of venous drainage on the flap survival of arterialized venous flaps. An arterialized venous flap was outlined symmetrically in the rabbit abdomen. The arterial perfusion flap with a unilateral vascular pedicle was taken as the control group and three other experimental groups (I, II and III) were designed based on the number of drainage veins (n = 1, 2 and 3 in the three groups, respectively). Compared with the control group, significant venous congestion was noted in all the experimental groups and the most severe one was seen in group I; while no statistical difference was observed between groups II and III. Similar results regarding blood perfusion state, epidermal metabolite levels and flap survival status were obtained among the three groups. These findings suggested that venous drainage is vital in the survival of the flap, but unlike in the arterial perfusion flaps, the problem of venous congestion can only be partially solved by increasing the number of draining veins. Further studies are warranted to gain insight into this complicated issue.
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Affiliation(s)
- Weidong Weng
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Zhang
- Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Bin Zhao
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhipeng Wu
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiyang Gao
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhijie Li
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hede Yan
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Ataman MG, Uysal CA, Ertas NM, Bayraktar N, Terzi A, Borman H. The effect of adipose stromal vascular fraction on transverse rectus abdominis musculocutaneous flap: an experimental study. J Plast Surg Hand Surg 2016; 50:272-80. [PMID: 27010192 DOI: 10.3109/2000656x.2016.1159217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the options in reconstruction after breast cancer surgery for breast reconstruction. Tissue necrosis often occurs in the third and fourth perfusion zones of the flap. A study was planned to find out the effects of adipose stromal vascular fraction (SVF) cells on viability of TRAM flap and the experimental model was designed to be applicable in clinical practice. METHODS Right inferior epigastric artery pedicled, 5 × 2.5 cm sized TRAM flap was used as a flap model in 30 rats in three groups (group 1: sham; group 2: phosphate-buffered saline (PBS); group 3: SVF cell injected). The viability of the flaps were assessed on the postoperative 7th day with photographs and software for the calculations. RESULTS The mean viable flap percentage to total flap area was recorded as 51.8% ± 11.19, 49.5% ± 10.30, 82.3% ± 9.56, in group 1, group 2, and group 3, respectively (p < 0.05). The mean capillary density was noted as 5.15 ± 0.56, 4.37 ± 0.58, and 12.40 ± 1.17 in groups 1, 2, and 3, respectively (p < 0.05). The fibrosis gradient indicated no difference between the groups (p > 0.05). The in-vivo differentiation of SVF cells to endothelial cells was noted. The blood VEGF levels showed a marked increase in the experimental group (p < 0.05). CONCLUSION The adipose SVF cells were found out to improve the TRAM flap viability and decrease necrosis, especially in zone 3 and 4.
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Affiliation(s)
- Murat Gorkem Ataman
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Cagri A Uysal
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Nilgun Markal Ertas
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Nilufer Bayraktar
- b Department of Biochemistry , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Aysen Terzi
- c Department of Pathology , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Huseyin Borman
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
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Hamilton K, Wolfswinkel EM, Weathers WM, Xue AS, Hatef DA, Izaddoost S, Hollier LH. The Delay Phenomenon: A Compilation of Knowledge across Specialties. Craniomaxillofac Trauma Reconstr 2014; 7:112-8. [PMID: 25071876 DOI: 10.1055/s-0034-1371355] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 12/19/2022] Open
Abstract
Objective The purpose of this article is to review and integrate the available literature in different fields to gain a better understanding of the basic physiology and optimize vascular delay as a reconstructive surgery technique. Methods A broad search of the literature was performed using the Medline database. Two queries were performed using "vascular delay," a search expected to yield perspectives from the field of plastic and reconstructive surgery, and "ischemic preconditioning," (IPC) which was expected to yield research on the same topic in other fields. Results The combined searches yielded a total of 1824 abstracts. The "vascular delay" query yielded 76 articles from 1984 to 2011. The "ischemic preconditioning" query yielded 6534 articles, ranging from 1980 to 2012. The abstracts were screened for those from other specialties in addition to reconstructive surgery, analyzed potential or current uses of vascular delay in practice, or provided developments in understanding the pathophysiology of vascular delay. 70 articles were identified that met inclusion criteria and were applicable to vascular delay or ischemic preconditioning. Conclusion An understanding of IPC's implementation and mechanisms in other fields has beneficial implications for the field of reconstructive surgery in the context of the delay phenomenon. Despite an incomplete model of IPC's pathways, the anti-oxidative, anti-apoptotic and anti-inflammatory benefits of IPC are well recognized. The activation of angiogenic genes through IPC could allow for complex flap design, even in poorly vascularized regions. IPC's promotion of angiogenesis and reduction of endothelial dysfunction remain most applicable to reconstructive surgery in reducing graft-related complications and flap failure.
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Affiliation(s)
| | | | | | - Amy S Xue
- Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel A Hatef
- Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Lucca AFD, Brasolin AG, Feitosa RGF, Enokihara MMSES, Gomes HFDC, Ferreira LM. Histological modification in TRAM flap in rats treated with pentoxifylline. Acta Cir Bras 2014; 29 Suppl 2:34-7. [DOI: 10.1590/s0102-86502014001400007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Yan H, Kolkin J, Zhao B, Li Z, Jiang S, Wang W, Xia Z, Fan C. The effect of hemodynamic remodeling on the survival of arterialized venous flaps. PLoS One 2013; 8:e79608. [PMID: 24265782 PMCID: PMC3827173 DOI: 10.1371/journal.pone.0079608] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/25/2013] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the effect of hemodynamic remodeling on the survival status of the arterialized venous flaps (AVFs) and investigate the mechanism of this procedure. Materials and Methods Two 7 x 9 cm skin flaps in each rabbit (n=36) were designed symmetrically in the abdomen. The thoracoepigastric pedicle and one femoral artery were used as vascular sources. Four groups were included: Composite skin grafts group and arterial perfusion group were designed in one rabbit; AVF group and hemodynamic remodeling group by ligation of the thoracoepigastric vein in the middle were outlined in another rabbit. Flap viability, status of vascular perfusion and microvasculature, levels of epidermal metabolite and water content in each group were assessed. Results Highly congested veins and simple trunk veins were found using angiography in the AVF group; while a fairly uniform staining and plenty of small vessels were observed in the hemodynamic remodeling group. The metabolite levels of the remodeling group are comparable with those in the arterial perfusion group. There was no statistically significant difference in the percentage of flap survival between the arterial perfusion group and hemodynamic remodeling group; however, significant difference was seen between the AVF group and the hemodynamic remodeling group. Conclusions Under the integrated perfusion mode, the AVFs are in an over-perfusion and non-physiological hemodynamic state, resulting in unreliability and unpredictability in flap survival; under the separated perfusion mode produced by remodeling, a physiological-like circulation will be created and therefore, better flap survival can be expected.
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Affiliation(s)
- Hede Yan
- Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Jon Kolkin
- Department of Plastic and Hand Surgery, Duke Raleigh Hospital, Raleigh, North Carolina, United States of America
| | - Bin Zhao
- Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Zhefeng Li
- Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Shichao Jiang
- Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Xia
- Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cunyi Fan
- Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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11
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Edmunds MC, Wigmore S, Kluth D. In situ transverse rectus abdominis myocutaneous flap: a rat model of myocutaneous ischemia reperfusion injury. J Vis Exp 2013. [PMID: 23770929 DOI: 10.3791/50473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury.
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Sönmez TT, Vinogradov A, Zor F, Kweider N, Lippross S, Liehn EA, Naziroglu M, Hölzle F, Wruck C, Pufe T, Tohidnezhad M. The effect of platelet rich plasma on angiogenesis in ischemic flaps in VEGFR2-luc mice. Biomaterials 2013; 34:2674-82. [PMID: 23352038 DOI: 10.1016/j.biomaterials.2013.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/03/2013] [Indexed: 11/19/2022]
Abstract
To improve skin flap healing, one promising strategy in reconstructive surgery might be to optimize platelet rich plasma (PRP) bioactivity and the ischemia-altered expression of genes. We studied both the effect of PRP on ischemic flaps, and whether in vivo bioluminescence imaging (BLI) is a suitable method for the longitudinal monitoring of angiogenesis in surgical wounds. Axial murine skin flaps were created in four experimental groups. In vivo measurements of VEGFR2 expression levels were made every other day until the 14th day. The local VEGF level and microvessel density were quantified on the 14th day via ELISA and immunohistochemistry, and flap survival rates were measured. We demonstrated that PRP and induced ischemia have a beneficial influence on angiogenesis and flap healing. Combining the two resulted in a significantly robust increase in angiogenesis and flap survival rate that was corroborated by bioluminescence imaging of VEGFR2 activity. This study shows that angiogenic effects of PRP may be potentialized by the stimulus of induced ischemia during free flap harvesting, and thus the two procedures appear to have a synergistic effect on flap healing. This study further demonstrates that BLI of modulated genes in reconstructive surgery is a valuable model for longitudinal in vivo evaluation of angiogenesis.
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Affiliation(s)
- Tolga Taha Sönmez
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany.
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Comparison of Extracorporal Shock Wave Pretreatment to Classic Surgical Delay in a Random Pattern Skin Flap Model. Plast Reconstr Surg 2011; 127:1830-1837. [DOI: 10.1097/prs.0b013e31820cf1fb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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An old dream revitalised: preconditioning strategies to protect surgical flaps from critical ischaemia and ischaemia-reperfusion injury. J Plast Reconstr Aesthet Surg 2008; 61:503-11. [DOI: 10.1016/j.bjps.2007.11.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 04/11/2007] [Accepted: 11/22/2007] [Indexed: 10/22/2022]
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Abstract
The technique of vascular delay has been used by plastic surgeons for nearly 500 years and has proven useful for reliably transferring tissue and allowing for a greater volume of tissue to be reliably harvested. Delay procedures are an essential plastic surgical tool for a variety of aesthetic and reconstructive procedures. Despite the widespread use of vascular delay procedures, the mechanism by which this phenomenon occurs remains unclear. A number of groups have exhaustively examined microvascular changes that occur during vascular delay. Theories have been proposed ranging from the dilation of choke vessels to changes in metabolism and new blood vessel formation. Inherent in these theories is the concept that ischemia is able to act as the primary stimulus for vascular changes. The purpose of this review is to revisit the theories proposed to underlie the delay phenomenon in light of recent advances in vascular biology. In particular, the participation of bone marrow-derived endothelial progenitor cells in the delay phenomenon is explored. Greater understanding of the role these cells play in new blood vessel formation will be of considerable clinical benefit to high-risk patients in future applications of delay procedures.
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Affiliation(s)
- Shadi Ghali
- London, United Kingdom; New York, N.Y.; and Stanford, Calif. From the Department of Plastic Surgery, Royal Free Hospital, University of London; Laboratory of Microvascular Research and Vascular Tissue Engineering, Institute of Reconstructive Plastic Surgery, New York University Medical Center; and Division of Plastic Surgery, Stanford University School of Medicine
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