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Xie T, Wang M, Zang M, Han T, Zhu S, Li S, Chen Z, Liu Y. Extrinsic Vascular Pathway Preservation Improves Survival in a Rat Three-Territory Flap Model Based on the Deep Circumflex Iliac Artery. Plast Reconstr Surg 2024; 153:1119e-1130e. [PMID: 37307047 DOI: 10.1097/prs.0000000000010843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Extended flaps are commonly applied for large defects. However, a postoperative flap necrosis incidence of 11% to 44% remains a major complication. Previous clinical studies have shown that maintaining the extrinsic vascular pathway (EVP) can increase the survival area of extended flaps. The authors hypothesized that preserving the EVP would improve flap survival by reducing blood resistance within the vascular territory. METHODS Twenty-four adult male Sprague-Dawley rats were used. Tissue samples were obtained from eight untreated rats as a baseline control. Three-territory flaps were elevated in the remaining 16 rats. The EVP was preserved or ligated. Flap perfusion was assessed immediately using indocyanine green angiography. Rats were euthanized on day 7. The flap survival area was measured using Adobe Photoshop. Hematoxylin and eosin staining, CD31 immunostaining, and Western blot analysis of vascular endothelial growth factor protein expression were used to quantitatively assess vasodilation and angiogenesis in choke zones. RESULTS Indocyanine green angiography revealed that blood could flow through the preserved EVP and perfuse the third vascular territory of the flap. EVP preservation significantly increased flap survival area (86.3%, 19.3% difference; P < 0.001), promoted vasodilation (5.0/choke zone, 3.0/choke zone difference; P = 0.013) and angiogenesis (29.3/mm 2 , 14.3/mm 2 difference; P = 0.002), and increased vascular endothelial growth factor expression (0.6, 0.2 difference; P = 0.067) in the second choke zone. CONCLUSIONS EVP preservation improves flap survival in this rat three-territory flap model. Further investigation in large-animal models is required for clinical translation. CLINICAL RELEVANCE STATEMENT Although further validation in large animal models and prospective clinical trials are necessary to verify the efficacy of the authors' hypothesis, their findings suggest that the EVP preservation procedure could provide an alternative for surgeons to create an extended flap in defect reconstruction.
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Affiliation(s)
- Tingjun Xie
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Miao Wang
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Mengqing Zang
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Tinglu Han
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Shan Zhu
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Shanshan Li
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zixiang Chen
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yuanbo Liu
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Fang B, Wang X, Sun Y, Xiong X, Meng X, Li W, Yi Z. Hypoxia-induced CCL2/CCR2 axis in adipose-derived stem cells (ADSCs) promotes angiogenesis by human dermal microvascular endothelial cells (HDMECs) in flap tissues. J Physiol Biochem 2023:10.1007/s13105-023-00944-6. [PMID: 36786974 DOI: 10.1007/s13105-023-00944-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023]
Abstract
Flap expansion has become an important method widely used in wound repair and organ reconstruction. However, distal skin flap ischemic necrosis remains a problematic complication. In this study, integrative bioinformatics analyses indicated the upregulation of C-C motif chemokine ligand 2 (CCL2) and C-C motif chemokine receptor 2 (CCR2) in reperfusion-exposed skin flap tissues. In adipose-derived stem cells (ADSCs, CD90-positive, CD29-positive, CD34-negative, and CD106-negative) exposed to hypoxia, HIF-1α and CCL2 levels were significantly elevated. Conditioned medium (CM) from hypoxia-stimulated ADSCs promoted HDMEC proliferation, migration, and tube formation, partially inhibited by sh-CCL2-induced CCL2 knockdown or neutralized antibody-induced CCL2 depletion in ADSCs. Consistently, CCL2, CCR2, TNF-α, TLR2, and TLR4 protein levels in HDMECs were significantly increased by hypoxia-treated ADSCs CM, and partially decreased by sh-CCL2-induced CCL2 knockdown or neutralizing antibody-induced CCL2 knockdown in ADSCs. In the flap expansion model, ADSCs transplantation significantly improved flap survival and angiogenesis by endothelial cells in flap tissues, whereas CCL2 knockdown in ADSCs partially eliminated the improvement by ADSCs transplantation; overexpression of CCL2 in ADSCs further promoted the effects of ADSCs transplantation on skin flap. In conclusion, the CCL2/CCR2 axis in ADSCs could be induced by hypoxia, promoting HDMEC proliferation, migration, and tube formation and improving flap survival and angiogenesis in flap tissues.
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Affiliation(s)
- Bairong Fang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yang Sun
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Xiang Xiong
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xianxi Meng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wenbo Li
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhongjie Yi
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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Zhang J, Liu Y, Zang M, Zhu S, Chen B, Li S, Xue B, Yan L. Lentivirus-mediated CDglyTK gene-modified free flaps by intra-artery perfusion show targeted therapeutic efficacy in rat model of breast cancer. BMC Cancer 2019; 19:921. [PMID: 31521130 PMCID: PMC6744674 DOI: 10.1186/s12885-019-6111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background Free flap-mediated gene therapy in the tumor bed following surgical resection is a promising approach in cancer targeted treatment of residual disease. We investigated the selective killing efficacy of a lentivirus-mediated cytosine deaminase-thymidine kinase (CDglyTK) gene in transplanted breast cancer delivered into a free flap by intra-artery perfusion. Methods Proliferation, apoptosis, and cell cycle of rat SHZ-88 breast cancer cells transfected with a lentivirus-mediated CD/TK gene were measured following treatment with ganciclovir and 5-flucytosine in vitro. A model of residual disease of breast cancer in a rat superficial inferior epigastric artery (SIEA) flap model was used to study the therapeutic potential of a double suicide CD/TK and prodrug system in vivo. Results Killing efficacy of the double suicide CD/TK and prodrug system on SHZ-88 cells was mediated by increased apoptosis and cell cycle arrest at the G1 phase with significant bystander effect. Following recombinant lentivirus transfection of rat SIEA flap by intra-artery perfusion, CD/TK gene expression was limited to the flap, and the volume and weight of transplanted tumors were significantly reduced without observable toxicity. Conclusions SIEA flaps transfected with a lentivirus-mediated CDglyTK gene by intra-artery perfusion effectively suppress transplanted breast tumor growth without obvious systemic toxic effects in rats. Electronic supplementary material The online version of this article (10.1186/s12885-019-6111-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianhua Zhang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Yuanbo Liu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Mengqing Zang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Shan Zhu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Bo Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Shanshan Li
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Bingjian Xue
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China
| | - Li Yan
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road 33#, Beijing, 100144, People's Republic of China.
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Kruit AS, Smits L, Pouwels A, Schreinemachers MCJM, Hummelink SLM, Ulrich DJO. Ex-vivo perfusion as a successful strategy for reduction of ischemia-reperfusion injury in prolonged muscle flap preservation - A gene expression study. Gene 2019; 701:89-97. [PMID: 30902788 DOI: 10.1016/j.gene.2019.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With the introduction of vascularized composite allotransplantation (VCA) as new surgical technique, the need arose for strategies that could safely prolong graft preservation. Ex-vivo machine perfusion is a promising technique and is currently applied in solid organ transplantation. There is still limited evidence in the field of VCA and free flap transplantation. This gene expression study aimed to assess the degree of ischemia-reperfusion (IR) injury after preservation and replantation of free muscle flaps in a porcine model. MATERIALS AND METHODS A microarray analysis was first conducted on muscle flaps preserved by ex-vivo perfusion versus cold storage, to select genes of interest for further investigation. The expression of these selected genes was then examined in a muscle flap replantation model after 18 hour ex-vivo perfusion (n = 14) using qRT-PCR. Two preservation solutions were compared to static cold storage: University of Wisconsin-mp (n = 5) and Histidine-Tryptophan-Ketoglutarate solution (n = 5). RESULTS A selection of 8 genes was made based on micro-array results: Tumor necrosis factor receptor superfamily member 10-A like, Regulator of G-protein signaling 2, Nuclear factor kappa beta inhibitor zeta, Interleukin-1 beta, Fibroblast growth factor 6 and DNA damage-inducible transcript 4, Hypoxia-inducible factor 1-alpha and Caspase-3. The muscle flap replantation experiment compared their expression patterns before and after preservation and replantation and showed overall comparable gene expression between the preservation groups. CONCLUSIONS The expression of genes related to ischemia, apoptosis and inflammation was comparable between the ex-vivo perfusion and static cold storage groups. These results suggest that ex-vivo perfusion might be a promising technique for 18 hour muscle preservation in terms of decreasing ischemia-reperfusion injury.
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Affiliation(s)
- Anne Sophie Kruit
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Laura Smits
- Medical Biology, Faculty of Science, Radboud University, Nijmegen, the Netherlands
| | - Angéle Pouwels
- HAN University of Applied Sciences, Nijmegen, the Netherlands
| | | | - Stefan L M Hummelink
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Luo Z, Wu P, Qing L, Zhou Z, Yu F, Zhang P, Tang J. The hemodynamic and molecular mechanism study on the choke vessels in the multi-territory perforator flap transforming into true anastomosis. Gene 2019; 687:99-108. [PMID: 30447343 DOI: 10.1016/j.gene.2018.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to explore the hemodynamic and morphological changes of the choke vessels, and to investigate the role of HIF-1α in the flap adaptation to hypoxic and choke vessel transformation after multi-territory perforator flap transplantation. METHODS Animal model of single pedicle multi-territory perforator flap was established in the back of SD rats and the blood supply characteristics were studied by gelatin-oxide perfusion technique. HE staining and stereomicroscope were used to observe vascular changes. Afterward, the influence of hypoxia on cell proliferation and apoptosis were detected by MTT assay and flow cytometry, respectively. Besides, the expression of HIF-1α, iNOS and VEGF expression of HUVECs under hypoxia were detected by qRT-PCR and Western blot. RESULTS The results revealed that all the choke vessels immediately began to expand after operation. The day after operation, some of the choke vessels continued to grow and expand, turning into the true anastomosis, while the others gradually dwindled and finally disappeared. Compared with the control group, the day after transplantation, the expression levels of both HIF-1α and iNOS were significantly increased. The only different was that HIF-1α was then maintained a high level, iNOS was significantly decreased aftertimes. What's more, the expression of VEGF was increased to the maximum at 3 days after operation and then decreased. In HUVECs, hypoxia increased the expression of HIF-1α, iNOS and VEGF protein. Besides, it also promoted the proliferation and inhibited the apoptosis. In addition, we also found that hypoxia-induced VEGF and iNOS upregulation is mediated by HIF-1α overexpression and HIF-1α knockout can reverse the effects induced by hypoxia. CONCLUSIONS We found that HIF-1α may participate in the early vascular dilatation of transregional skin flap by inducing iNOS expression and promoting the reconstruction of choke vessels through increase VEGF expression.
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Affiliation(s)
- Zhenhua Luo
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Liming Qing
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Zhengbing Zhou
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Peiyao Zhang
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
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Ballestín A, Casado JG, Abellán E, Vela FJ, Álvarez V, Usón A, López E, Marinaro F, Blázquez R, Sánchez-Margallo FM. Ischemia-reperfusion injury in a rat microvascular skin free flap model: A histological, genetic, and blood flow study. PLoS One 2018; 13:e0209624. [PMID: 30589864 PMCID: PMC6307726 DOI: 10.1371/journal.pone.0209624] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 12/29/2022] Open
Abstract
Ischemia reperfusion injury is associated with tissue damage and inflammation, and is one of the main factors causing flap failure in reconstructive microsurgery. Although ischemia-reperfusion (I/R) injury is a well-studied aspect of flap survival, its biological mechanisms remain to be elucidated. To better understand the biological processes of ischemia reperfusion injury, and to develop further therapeutic strategies, the main objective of this study was to identify the gene expression pattern and histological changes in an I/R injury animal model. Fourteen rats (n = 7/group) were randomly divided into control or ischemia-reperfusion group (8 hours of ischemia). Microsurgical anastomoses were objectively assessed using transit-time-ultrasound technology. Seven days after surgery, flap survival was evaluated and tissue samples were harvested for anatomopathological and gene-expression analyses.The I/R injury reduced the survival of free flaps and histological analyses revealed a subcutaneous edema together with an inflammatory infiltrate. Interestingly, the Arginase 1 expression level as well as the ratio of Arginase 1/Nitric oxide synthase 2 showed a significant increase in the I/R group. In summary, here we describe a well-characterized I/R animal model that may serve to evaluate therapeutic agents under reproducible and controlled conditions. Moreover, this model could be especially useful for the evaluation of arginase inhibitors and different compounds of potential interest in reconstructive microsurgery.
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Affiliation(s)
- Alberto Ballestín
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
- * E-mail:
| | - Javier G. Casado
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Elena Abellán
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - F. Javier Vela
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Verónica Álvarez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Alejandra Usón
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Esther López
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Federica Marinaro
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Rebeca Blázquez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco Miguel Sánchez-Margallo
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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Bao T, He J, Yu C, Zhao W, Lin Y, Wang H, Liu J, Zhu H. Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap. Oral Oncol 2017; 75:133-139. [DOI: 10.1016/j.oraloncology.2017.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
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Hsu CE, Shyu VBH, Wen CJ, Wei FC, Huang XT, Cheng HY. The rat groin flap model redesigned for evaluating treatment effects on ischemia-reperfusion injury. J Surg Res 2017; 222:160-166. [PMID: 29273367 DOI: 10.1016/j.jss.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/08/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although there is a wide application of the rat extended groin flap (epigastric skin flap) in studying different clinical issues, inconsistency arises between studies because many parameters of the extended groin flap have not been well defined. MATERIALS AND METHODS The flap is based on the superficial inferior epigastric vessels, which give into a lateral and a medial branch distally. Herein, three steps were taken to redesign this model: First, the ventral vascular anatomy was visualized through an imaging study to determine the flap borders. Second, different ischemic durations were induced on five groups of Lewis rats (n = 5 in each group) by clamping the femoral artery; group 1 (sham group) received no ischemic insult after elevation and was immediately repositioned, and groups 2, 3, 4, and 5 received 12-, 14-, 16-, and 18-hour ischemia, respectively. Percentage of necrosis area was measured after 5 days. Third, the redesigned groin flap model was tested with the ischemic postconditioning for validation. RESULTS The flap borders were determined such that both branches of the superficial inferior epigastric vessels were always included to ensure blood supply consistency. As the 14-hour ischemia induced the least variation in necrotic area on rats, it was chosen for further studies. In addition, ischemic postconditioning after 14-hr ischemia resulted in significant reduction of necrosis in this model. CONCLUSIONS We have redesigned the extended groin flap model with better-defined borders and consistent vascular anatomy. The ischemia duration was calibrated with predictable necrosis pattern and the practicality was demonstrated. With this model, precise assessment of treatment efficacies on ischemia-reperfusion injury could be achieved in future studies.
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Affiliation(s)
- Chung-En Hsu
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Gueishan, Taiwan
| | - Victor Bong-Hang Shyu
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Gueishan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Gueishan, Taiwan
| | - Chih-Jen Wen
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Gueishan, Taiwan; College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - Fu-Chan Wei
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Gueishan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Gueishan, Taiwan; College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - Xiao-Ting Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Gueishan, Taiwan
| | - Hui-Yun Cheng
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Gueishan, Taiwan.
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The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1074178. [PMID: 28589130 PMCID: PMC5447266 DOI: 10.1155/2017/1074178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/09/2017] [Indexed: 02/04/2023]
Abstract
Introduction While studies using various materials to overcome ischemia-reperfusion (IR) injury are becoming increasingly common, studies on the effects of botulinum toxin A (BoTA) on IR injury in musculocutaneous flaps are still limited. The purpose of this study was to examine our hypotheses that BoTA provide protection of musculocutaneous flap from ischemia-reperfusion injury. Method Five days after pretreatment injection (BoTA versus normal saline), a right superior musculocutaneous flap (6 × 1.5 cm in size) was made. Ischemia was created by a tourniquet strictly wrapping the pedicle containing skin and muscle for 8 h. After ischemia, the tourniquet was cut, and the musculocutaneous flap was reperfused. Results The overall survival percentage of flap after 8 h of pedicle clamping followed by reperfusion was 87.32 ± 3.67% in the control group versus 95.64 ± 3.25% in the BoTA group (p < 0.001). The BoTA group had higher expression of CD34, HIF-1α, VEGF, and NF-kB comparing to control group in qRT-PCR analysis. Conclusions In this study, we found that local BoTA preconditioning yielded significant protection against IR injury in a rat musculocutaneous flap model.
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Stanger K, Horch RE, Dragu A. Severe mutilating injuries with complex macroamputations of the upper extremity - is it worth the effort? World J Emerg Surg 2015; 10:30. [PMID: 26170897 PMCID: PMC4499889 DOI: 10.1186/s13017-015-0025-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/30/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction An amputation of the upper extremity and the following replantation is still one of the most challenging operations in the field of reconstructive surgery, especially in extremely severe cases of combined mutilating macroamputations including avulsion and multilevel injuries. Specialists agree that macroamputations with sharp wound edges are an absolute indication for replantation. However, there is no agreement in disastrous cases including avulsion and multilevel injuries. The outcome of the operation is depending on several factors, including the type of accident, age and pre-existing disease of the patient, as well as time of ischemia and appropriate physical therapy. Methods Between January 1st 2003 and December 31st 2011 six patients underwent a macroreplantation with disastrous combined and complex injuries of the upper extremity in our department. We performed a follow up and evaluated the functional outcome of the upper extremity function using the DASH questionnaire (average follow up of 3.1 years). Results The mean time of ischemia was 04:50 h (02:46 h–06:17 h). The mean time for the operation was 05:30 h (01:55 h–08:20 h). The mean operations needed per patient were 7 (2–16). The average hospital stay was 29d (16–59d). According to the DASH-Score from five out of six patients the functional outcome of the replanted extremity has a mean score of 71 points. The versatility of the replanted extremity in the field of work had 95, and sport, music was assessed with a mean score of 96 points. Conclusions Severe and disastrous combined and complex macroamputations of the upper extremity may also have an absolute indication for replantation even though the functional outcome is poor. Not only the feeling of physical integrity can be restored, but the replantation of an amputated upper extremity enables complete or partial recovery of function and sensibility of the arm which is important for the individual. Although our results show a very high DASH-Score, those achievements justify time and person consuming operations. In most cases a replanted extremity is still superior to a secondary allotransplantation. Usually the use of prosthesis is not favored by the treated patients.
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Affiliation(s)
- Katrin Stanger
- Department of Plastic and Hand Surgery, OKM Orthopädische Klinik Markgröningen gGmbH, Markgröningen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Klinikum St. Georg gGmbH, Leipzig, Germany
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12
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Neovascularization in tissue engineering. Cells 2012; 1:1246-60. [PMID: 24710553 PMCID: PMC3901123 DOI: 10.3390/cells1041246] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/08/2012] [Accepted: 12/05/2012] [Indexed: 01/09/2023] Open
Abstract
A prerequisite for successful tissue engineering is adequate vascularization that would allow tissue engineering constructs to survive and grow. Angiogenic growth factors, alone and in combination, have been used to achieve this, and gene therapy has been used as a tool to enable sustained release of these angiogenic proteins. Cell-based therapy using endothelial cells and their precursors presents an alternative approach to tackling this challenge. These studies have occurred on a background of advancements in scaffold design and assays for assessing neovascularization. Finally, several studies have already attempted to translate research in neovascularization to clinical use in the blossoming field of therapeutic angiogenesis.
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Seth R, Khan AA, Pencavel T, Harrington KJ, Harris PA. Targeted gene delivery by free-tissue transfer in oncoplastic reconstruction. Lancet Oncol 2012; 13:e392-402. [DOI: 10.1016/s1470-2045(12)70235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dragu A, Taeger CD, Buchholz R, Sommerfeld B, Hübner H, Birkholz T, Kleinmann JA, Münch F, Horch RE, Präbst K. Online oxygen measurements in ex vivo perfused muscle tissue in a porcine model using dynamic quenching methods. Arch Orthop Trauma Surg 2012; 132:655-61. [PMID: 22246464 DOI: 10.1007/s00402-011-1458-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Transplantation of autologous free tissue flaps is the best applicable technique for treating large and complex tissue defects and still has one major failure criterion. Tissue--and in particular muscle tissue--is strongly sensitive to ischemia, thus after a critical period of oxygen depletion the risk of a partial or total flap loss is high. MATERIALS AND METHODS For that reason a miniaturized ex vivo perfusion system has been developed, that supplies the tissue during operational delays. The purpose of this study was to determine the oxygenation levels during such a perfusion using different perfusates and therefore to objectify if a complementary oxygenation unit is required to improve perfusion quality. The oxygen levels of the tissue, as well of the perfusate, were measured by using minimal invasive optical oxygen sensors that are based on dynamic quenching. The ex vivo perfused tissue was the porcine rectus abdominis muscle. RESULTS Results show, that during perfusion with heparinized crystalloid fluid (Jonosteril) and heparinized autologous whole blood, additional oxygenation of the perfusion reactor led to different ex vivo oxygen tissue saturations, which can be detected by dynamic quenching. CONCLUSION Dynamic quenching methods are a promising and valuable technique to perform online oxygen measurements in ex vivo perfused muscle tissue in a porcine model.
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Affiliation(s)
- Adrian Dragu
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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Bonnas C, Specht K, Spleiss O, Froehner S, Dietmann G, Krüger JM, Arbogast S, Feuerhake F. Effects of cold ischemia and inflammatory tumor microenvironment on detection of PI3K/AKT and MAPK pathway activation patterns in clinical cancer samples. Int J Cancer 2012; 131:1621-32. [PMID: 22213219 DOI: 10.1002/ijc.27422] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/13/2011] [Indexed: 11/07/2022]
Abstract
The accuracy of common markers for PI3K/AKT and MAPK pathway activation in preclinical and clinical cancer biomarker studies depends on phosphoepitope stability and changes of phosphorylation under ischemia. Herein, we define conditions under which phosphoepitope-specific duplex immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tumor tissues reflects pathway activation in situ as accurately as possible, and identify activation patterns linked to mutational status, pathway dependency and tumor microenvironment in clinical tumor samples, cell culture and xenograft tissues. Systematically assessing robustness of pAKT, pERK1/2, pMEK1/2 and pmTOR detection and related markers in xenograft tissues exposed to ischemia, we show that control of preprocessing and ischemia times allows accurate interpretation of staining results. Phosphorylation patterns were then analyzed in 33 xenograft models and in 58 cases with breast cancer, including 21 paired samples of core-needle biopsies with corresponding mastectomy specimens, and 37 mastectomy samples obtained under rigorously controlled conditions minimizing ischemia time. Patterns of pAKT and pERK1/2 staining (predominant PI3K/AKT, predominant MAPK and concomitant activation) were associated with sensitivity to pathway inhibition and partially with the mutational status in cell lines and corresponding xenograft tumors. In contrast, no clear correlation between mutational status and staining patterns was observed in clinical breast cancer samples, suggesting that interaction with the human tumor microenvironment may interfere with the use of phosphoepitope-specific IHC as potential markers for pathway dependency. In contrast to core needle biopsies, surgically resected breast cancer samples showed evidence of severe signal changes comparable to those effects observed in xenograft tumors exposed to controlled ischemia.
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Affiliation(s)
- Christel Bonnas
- Roche Pharma Research and Early Development, Penzberg, Germany
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