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Tsuchiya M, Kushibiki T, Yamashiro T, Mayumi Y, Ishihara M, Azuma R. Continuous negative-pressure wound therapy improves the survival rate of skin grafts and shortens the time required for skin graft survival. Skin Res Technol 2024; 30:e13865. [PMID: 39031918 PMCID: PMC11259545 DOI: 10.1111/srt.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 06/29/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND The effectiveness of negative-pressure wound therapy (NPWT) in skin graft fixation has been demonstrated in several clinical studies. However, in vitro and in vivo studies on skin graft fixation with NPWT have been scarce. In this in vivo study, we aimed to determine whether NPWT fixation enhances skin graft survival and how it contributes to improving skin graft survival biologically. MATERIALS AND METHODS We harvested skin from the bilateral abdominal wall of 88 mice after anesthetizing them. Full-thickness skin grafts (FTSGs) were performed on contralateral harvest sites, and grafts were fixed using NPWT (continuous and intermittent modes), conventional compression methods, and wrapping with polyurethane foam as a control group. On days 5 and 10 of grafting, the survival rates of the FTSGs were evaluated. Immunohistopathological analysis and measurement of the expression levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-2), and epidermal growth factor (EGF) were performed. RESULTS The survival rates of FTSG in the continuous NPWT group were significantly higher than those in the other groups. The number of capillaries in the dermis was significantly higher in the continuous NPWT group than in the other groups. In the wound bed, VEGF levels were significantly higher in both NPWT groups than in the other groups. CONCLUSION Continuous NPWT increases the survival rate of FTSGs and shortens the duration of skin graft survival.
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Affiliation(s)
- Masato Tsuchiya
- Department of Plastic and Reconstructive SurgeryNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Toshihiro Kushibiki
- Department of Medical EngineeringNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Toshifumi Yamashiro
- Department of Plastic and Reconstructive SurgeryNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Yoshine Mayumi
- Department of Medical EngineeringNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Miya Ishihara
- Department of Medical EngineeringNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive SurgeryNational Defense Medical CollegeTokorozawaSaitamaJapan
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Chen G, Yang J, Wang A, Deng J, Wang K, Ye M, Chen Q, Wang X, Wu X, Lin D. L-Borneol promotes skin flap survival by regulating HIF-1α/NF-κB pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117543. [PMID: 38056540 DOI: 10.1016/j.jep.2023.117543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The clinical application of skin flaps in surgical reconstruction is frequently impeded by the occurrence of distant necrosis. L-Borneol exhibits myogenic properties in traditional Chinese medicine and is used in clinical settings to promote wound healing and conditions such as stroke. Nevertheless, the precise mechanism by which borneol exerts its protective effects on skin flap survival remains unclear. AIM OF THE STUDY To explore the potential of L-borneol to promote skin flap survival and elucidate the underlying mechanisms. MATERIALS AND METHODS Thirty-six male Sprague-Dawley rats were randomly divided into three groups: a high-dose (200 mg/kg L-borneol per day), a low-dose (50 mg/kg/day), and control group (same volume of solvent). In each rat, a modified rectangular McFarlane flap model measuring 3 × 9 cm was constructed. Daily intragastric administration of L-borneol or solvent was performed. The flap was divided into three square sections of equal size, namely Zone I (the proximal zone), Zone II (the intermediate zone), and Zone III (the distal zone). The survival rate was quantified, and the histological state of each flap was evaluated on the seventh day following the surgical procedure. The assessment of angiogenesis was conducted using lead oxide/gelatin angiography, whereas the evaluation of blood flow in the free flap was performed using laser Doppler flow imaging. Superoxide dismutase activity was detected using the water-soluble tetrazolium salt-8 method. The quantities of vascular endothelial growth factor, interleukin (IL)-1β, IL-6, and tumour necrosis factor-α were determined using immunohistochemistry. The levels of nuclear transcription factor-κB, hypoxia-inducible factor-1, B-cell lymphoma-2 (BCL-2), and BCL-2-associated X (BAX) were determined by Western blotting technique. RESULTS Flap survival rate significantly improved and neutrophil recruitment and release were enhanced after treatment with the compound. Angiogenesis was promoted. L-borneol protected against oxidative stress by increasing superoxide dismutase activity and decreasing malondialdehyde content. It downregulated the hypoxia-inducible factor nuclear transcription factor-κB pathway, leading to the inhibition of several inflammatory factors. Simultaneously, it facilitated the expression of vascular endothelial growth factor and BCL-2. CONCLUSION The study shows that L-borneol may promote skin flap survival by inhibiting HIF-1α/NF-κB pathway.
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Affiliation(s)
- Guodong Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Jialong Yang
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - An Wang
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Jiapeng Deng
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Kaitao Wang
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Minle Ye
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Qingyu Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinye Wang
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinyu Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, The First School of Clinical Medical, Wenzhou Medical, China
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, China.
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3
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Chen J, Jiang Z, Liu X, Wang K, Fan W, Chen T, Li Z, Lin D. Berberine promotes the viability of random skin flaps via the PI3K/Akt/eNOS signaling pathway. Phytother Res 2023; 37:424-437. [PMID: 36116786 DOI: 10.1002/ptr.7621] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
Abstract
Random skin flaps are often used in reconstruction operations. However, flap necrosis is still a common postoperative complication. Here, we investigated whether berberine (C20 H19 NO5 , BBR), a drug with antioxidant activity, improves the survival rate of random flaps. Fifty-four rats were divided into three groups: control, BBR and BBR + L -NAME groups (L -NAME, L -NG -Nitro-arginine methyl ester). The survival condition and the percentage of survival area of the flaps were evaluated on the seventh day after surgery. After animals were sacrificed, angiogenesis, apoptosis, oxidative stress and inflammation levels were assessed by histological and protein analyses. Our findings suggest that berberine promotes flap survival. The level of angiogenesis increased; the levels of oxidative stress, inflammation and apoptosis decreased; the levels of phosphoinositide 3-kinase (PI3K), phospho-Akt (p-Akt) and phospho-endothelial nitric oxide synthase (p-eNOS) increased in the flap tissue; and L -NAME reversed the effects of berberine on random skin flaps. Statistical analysis showed that the BBR group results differed significantly from those of the control and the BBR + L -NAME groups (p < .05). Our results confirm that berberine is an effective drug for significantly improving the survival rate of random skin flaps by promoting angiogenesis, inhibiting inflammation, attenuating oxidative stress, and reducing apoptosis through the PI3K/Akt/eNOS signaling pathway.
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Affiliation(s)
- Jianpeng Chen
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhikai Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xuao Liu
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Kaitao Wang
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Weijian Fan
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Tingxiang Chen
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhijie Li
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dingsheng Lin
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Wang Y, Li X, Lv H, Sun L, Liu B, Zhang X, Xu X. Therapeutic potential of naringin in improving the survival rate of skin flap: A review. Front Pharmacol 2023; 14:1128147. [PMID: 36937856 PMCID: PMC10017745 DOI: 10.3389/fphar.2023.1128147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Naringin is the main component of Drynaria. Modern pharmacological studies have shown that naringin has a wide range of pharmacological activities, including antioxidant, anti-inflammatory, anti-apoptotic, anti-ulcer, and anti-osteoporosis effects. Its therapeutic effects have been observed in various clinical models, such as atherosclerosis, cardiovascular diseases, diabetes, neurodegenerative diseases, and rheumatic diseases. This review investigates the pharmacological effects of naringin and the associated mechanisms in improving flap survival. This review will also provide a reference for future rational application of naringin, especially in research to improve flap survival.
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Affiliation(s)
- Yincang Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaodong Li
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hang Lv
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lin Sun
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Bo Liu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaofeng Zhang
- Teaching and Research Section of Orthopedics and Traumatology, Heilongjiang University of Chinese Medicine, Harbin, China
- *Correspondence: Xiaofeng Zhang, ; Xilin Xu,
| | - Xilin Xu
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- *Correspondence: Xiaofeng Zhang, ; Xilin Xu,
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5
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Yang L, Guo J, He J, Shao J. Skin grafting treatment of adolescent lower limb avulsion injury. Front Surg 2022; 9:953038. [PMID: 36189402 PMCID: PMC9521200 DOI: 10.3389/fsurg.2022.953038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Under the influence of various factors, the number of lower extremity avulsion injuries in adolescents is increasing year by year. The main modality of treatment is skin grafting. There are many types of skin grafting. Although many studies on skin grafting after avulsion injuries have been published in the past few decades, there are differences in the treatment options for adolescents with post avulsion injuries. Main body Thorough debridement and appropriate skin grafts are essential for the surgical management of avulsion injuries for optimal prognosis. In the acquisition of grafts, progress has been made in equipment for how to obtain different depths of skin. The severity of the avulsion injury varies among patients on admission, and therefore the manner and type of skin grafting will vary. Especially in adolescents, graft survival and functional recovery are of great concern to both patients and physicians. Therefore, many efforts have been made to improve survival rate and activity. Conclusion This review summarizes the principles of treatment of avulsion injuries, the historical development of skin grafts, and the selection of skin grafts, hoping to be helpful for future research.
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Lineaweaver WC. Teachers: 2021 Upchurch Lecture. Ann Plast Surg 2022; 88:S392-S402. [PMID: 37740506 DOI: 10.1097/sap.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Examples of influential teachings are drawn from the 6 decades of a single surgeon's education.
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Arribas-López E, Zand N, Ojo O, Snowden MJ, Kochhar T. A Systematic Review of the Effect of Centella asiatica on Wound Healing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3266. [PMID: 35328954 PMCID: PMC8956065 DOI: 10.3390/ijerph19063266] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Under metabolic stress conditions, there is a higher demand for nutrients which needs to be met. This is to reduce the risk of delay in wound healing which could lead to chronic wound. AIM This is a systematic review of the effect of Centella asiatica on wound healing. C. asiatica is a traditional medicinal plant used due to its antimicrobial, antioxidant, anti-inflammatory, neuroprotective, and wound healing properties. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for the systematic review and four electronic databases were used. RESULTS Four clinical trials met the inclusion criteria. The following distinct areas were identified under C. asiatica: wound contraction and granulation; healing/bleeding time and re-epithelialization; VAS (visual analogue scale) scores; skin erythema and wound appearance. CONCLUSIONS C. asiatica might enhance wound healing resulting from improved angiogenesis. This might occur due to its stimulating effect on collagen I, Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF) production. Besides, C. asiatica has shown an anti-inflammatory effect observed by the reduction in Interleukin-1β (IL-1β), Interleukin-6 (IL-6) and Tumour Necrosis Factor α (TNFα), prostaglandin E2 (PGE2), cyclooxygenase-2 (COX-2), and lipoxygenase (LOX) activity. Delivery systems such as nanoencapsulation could be used to increase C. asiatica bioavailability. Nevertheless, more studies are needed in order to perform a meta-analysis and ascertain the effects of C. asiatica on wound healing and its different parameters.
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Affiliation(s)
- Elena Arribas-López
- School of Science, Medway Campus, University of Greenwich, Central Ave, Gillingham, Chatham Maritime, Kent ME4 4TB, UK; (E.A.-L.); (N.Z.); (M.J.S.)
| | - Nazanin Zand
- School of Science, Medway Campus, University of Greenwich, Central Ave, Gillingham, Chatham Maritime, Kent ME4 4TB, UK; (E.A.-L.); (N.Z.); (M.J.S.)
| | - Omorogieva Ojo
- School of Health Sciences, Avery Hill Campus, University of Greenwich, Avery Hill Road, London SE9 2UG, UK
| | - Martin John Snowden
- School of Science, Medway Campus, University of Greenwich, Central Ave, Gillingham, Chatham Maritime, Kent ME4 4TB, UK; (E.A.-L.); (N.Z.); (M.J.S.)
| | - Tony Kochhar
- HCA London Bridge Hospital, Tooley Street, London SE1 2PR, UK;
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8
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Bali U, Aydemir I, Keçeci Y, Yoleri L, Tuğlu Mİ. Effects of oxidative stress and apoptosis on vascularity and viability of perforator flaps. Biotech Histochem 2020; 96:526-535. [PMID: 33107764 DOI: 10.1080/10520295.2020.1831066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We investigated lateral thoracic and posterior thigh perforator flaps for viability, vascularization, perfusion and apoptosis in a rat model. Wistar albino rats were divided into six groups: lateral thoracic artery perforator flap (LTPF) sham, 3 × 2 cm2 LTPF, 3 × 6 cm2 LTPF, posterior thigh perforator flap (PTPF) sham, 3 × 2 cm2 PTPF, and 3 × 6 cm2 PTPF. Flap viability was determined on postoperative days 1 and 7. On day 7, flaps were photographed and their viability was measured using two-dimensional planimeter paper. Tissue samples were harvested for examination by histology and immunohistochemistry. Viability differences were statistically significant. Epithelial thickness, vascularity and number of fibroblasts were reduced in the 3 × 6 cm2 groups. Neovascularization and apoptosis based on molecular tests were not significantly different among groups. Flap size and location are important factors for closure of surgical or traumatic defects. We suggest that for clinical application, wound complications will occur less frequently with perforators that nourish large areas of flaps.
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Affiliation(s)
- Ulaş Bali
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Işıl Aydemir
- Faculty of Medicine, Department of Histology and Embryology, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Yavuz Keçeci
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Levent Yoleri
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Mehmet İbrahim Tuğlu
- Faculty of Medicine, Department of Histology and Embryology, Manisa Celal Bayar University, Manisa, Turkey
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9
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He JB, Fang MJ, Ma XY, Li WJ, Lin DS. Angiogenic and anti-inflammatory properties of azadirachtin A improve random skin flap survival in rats. Exp Biol Med (Maywood) 2020; 245:1672-1682. [PMID: 32867550 DOI: 10.1177/1535370220951896] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Random skin flaps are widely used to repair tissue defects. However, the distal flap regions are prone to ischemic necrosis, limiting clinical applications. Azadirachtin A, a fruit extract from the neem, improves tissue blood supply and metabolism, reduces cell swelling, promotes tissue healing, and prevents venous thrombosis. We explored whether it enhances random skin flap survival. Fifty-four Sprague-Dawley rats were divided into control, low-dose, and high-dose Azadirachtin A-treated groups using a random number table. We used an improved version of the McFarlane technique to create flaps. On day 2, superoxide dismutase and malondialdehyde levels were measured. Tissue slices prepared on day 7 were stained with hematoxylin and eosin. The expression levels of vascular endothelial growth factor (VEGF), toll-like receptor 4 (TLR4), nuclear factor kappa-B (NF-kB), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were immunohistochemically assayed. Microcirculatory blood flow was measured via laser Doppler blood flowmetry. Flap angiography was performed using the lead-oxide gelatin injection technique. And the azadirachtin A groups exhibited a greater mean flap survival area, an improved mean blood vessel density, a greater blood flow, and higher superoxide dismutase and VEGF levels, especially at the high dose. Azadirachtin A markedly reduced the levels of TNF-α, IL-6, IL-1β, TLR4, and NF-kB. These findings suggest that azadirachtin A promotes random skin flap survival by improving the blood supply, reducing tissue inflammation, and inhibiting flap ischemia reperfusion injury.
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Affiliation(s)
- Ji-Bing He
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second Clinical College of Wenzhou Medical University, Wenzhou 325027, China
| | - Miao-Jie Fang
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second Clinical College of Wenzhou Medical University, Wenzhou 325027, China
| | - Xin-Yi Ma
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second Clinical College of Wenzhou Medical University, Wenzhou 325027, China
| | - Wen-Jie Li
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second Clinical College of Wenzhou Medical University, Wenzhou 325027, China
| | - Ding-Sheng Lin
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second Clinical College of Wenzhou Medical University, Wenzhou 325027, China
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Unverdi OF, Coruh A. Effects of microneedle length and duration of preconditioning on random pattern skin flaps in rats. J Plast Reconstr Aesthet Surg 2020; 73:1758-1767. [PMID: 32473851 DOI: 10.1016/j.bjps.2020.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
To date, the surgical delay of skin flaps is the most common and reliable method that increases skin flap survival. In this study, we aimed to increase skin flap viability using preconditioning by microneedling. Seventy-two Sprague Dawley rats were randomly divided into control, surgical flap delay (SFD), and four microneedling groups (7 or 14 days of preconditioning with 0.5 mm or 1 mm needles). Modified McFarlane flaps were raised on the back of rats. In Group I, a caudal pedicled skin flap was raised and the flap survival rate was assessed on postoperative day 14. In the SFD group, a bipedicled flap was created and after 14 days of surgical delay, all skin flaps were raised. In the microneedling groups, 0.5 mm or 1 mm needles were used for 7 or 14 days. The flap survival rates of all microneedling and SFD groups were significantly higher than the control group. The plasma levels of vascular endothelial growth factor (VEGF) did not significantly differ between groups, but the VEGF level of skin samples in the SFD group was higher than the control group. The vessel counts of all microneedling and SFD groups were statistically higher than the control group in all skin samples taken before raising the flaps, but skin samples taken 14 days after raising the skin flap did not show any difference between groups. We showed that preconditioning by microneedling can be used to improve the viability of critical ischemic skin flaps at a level similar to surgical delay.
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Affiliation(s)
- Omer Faruk Unverdi
- Erciyes University Medical Faculty Department of Plastic Reconstructive and Aesthetic Surgery, Köşk Mahallesi Dede Efendi Sokağı P.K. 38030 Melikgazi, Kayseri, Turkey
| | - Atilla Coruh
- Medical Faculty, Department of Plastic Reconstructive and Aesthetic Surgery, Erciyes University, Kayseri, Turkey.
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Zheng W, Wang J, Xie L, Xie H, Chen C, Zhang C, Lin D, Cai L. An injectable thermosensitive hydrogel for sustained release of apelin-13 to enhance flap survival in rat random skin flap. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:106. [PMID: 31502009 DOI: 10.1007/s10856-019-6306-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
With the advantage of handy process, random pattern skin flaps are generally applied in limb reconstruction and wound repair. Apelin-13 is a discovered endogenous peptide, that has been shown to have potent multiple biological functions. Recently, thermosensitive gel-forming systems have gained increasing attention as wound dressings due to their advantages. In the present study, an apelin-13-loaded chitosan (CH)/β-sodium glycerophosphate (β-GP) hydrogel was developed for promoting random skin flap survival. Random skin flaps were created in 60 rats after which the animals were categorized to a control hydrogel group and an apelin-13 hydrogel group. The water content of the flap as well as the survival area were then measured 7 days post-surgery. Hematoxylin and eosin staining was used to evaluate the flap angiogenesis. Cell differentiation 34 (CD34) and vascular endothelial growth factor (VEGF) levels were detected by immunohistochemistry and Western blotting. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were assessed by enzyme linked immunosorbent assays (ELISAs). Oxidative stress was estimated via the activity of tissue malondialdehyde (MDA) and superoxide dismutase (SOD). Our results showed that CH/β-GP/apelin-13 hydrogel could not only reduce the tissue edema, but also improve the survival area of flap. CH/β-GP/apelin-13 hydrogel also upregulated levels of VEGF protein and increased mean vessel densities. Furthermore, CH/β-GP/apelin-13 hydrogel was shown to significantly inhibit the expression of TNF-α and IL-6, along with increasing the activity of SOD and suppressing the MDA content. Taken together, these results indicate that this CH/β-GP/apelin-13 hydrogel may be a potential therapeutic way for random pattern skin flap.
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Affiliation(s)
- Wenhao Zheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Linzhen Xie
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Huanguang Xie
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Chunhui Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Chuanxu Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Dingsheng Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Leyi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
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12
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Effects of batroxobin treatment on the survival of random skin flaps in rats. Int Immunopharmacol 2019; 72:235-242. [DOI: 10.1016/j.intimp.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 01/26/2023]
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Effects of red and near-infrared LED light therapy on full-thickness skin graft in rats. Lasers Med Sci 2019; 35:157-164. [DOI: 10.1007/s10103-019-02812-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
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Feng X, Huang D, Lin D, Zhu L, Zhang M, Chen Y, Wu F. Effects of Asiaticoside Treatment on the Survival of Random Skin Flaps in Rats. J INVEST SURG 2019; 34:107-117. [PMID: 30898065 DOI: 10.1080/08941939.2019.1584255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Asiaticoside (AS) is extracted from the traditional herbal medicine Centella asiatica, and has angiogenic, antioxidant, anti-inflammatory, and wound-healing effects. We investigated the effects of AS on skin flap survival. Methods: Dorsal McFarlane flaps were harvested from 36 rats and divided into two groups: an experimental group treated with 40 mg/kg AS administered orally once daily, and a control group administered normal saline in an identical manner. On day 2, superoxide dismutase (SOD) and malondialdehyde (MDA) levels, and production of the cytokines tumor necrosis factor-α and interleukin (IL)-6 were evaluated. On day 7, tissue slices were stained with hematoxylin and eosin. The expression of vascular endothelial growth factor (VEGF), IL-6, and IL-1β were immunohistochemically evaluated. Microcirculatory flow was measured using laser Doppler flowmetry. Flap angiography, using the lead oxide-gelatin injection technique, was performed with the aid of a soft X-ray machine. Results: The AS group exhibited greater mean flap survival area, improved microcirculatory flow, and higher expression levels of SOD and VEGF compared with the control group. However, MDA levels and the inflammatory response were significantly reduced. Conclusions: AS exhibits promise as a therapeutic option due to its effects on the viability and function of random skin flaps in rats.
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Affiliation(s)
- Xiguang Feng
- Department of Orthopedics, People's Hospital of YingDe City Guangdong Province, Yingde City, China
| | - Dong Huang
- Department of Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lilin Zhu
- Department of Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Min Zhang
- Department of Orthopedics, People's Hospital of YingDe City Guangdong Province, Yingde City, China
| | - Yi Chen
- Department of Orthopedics, People's Hospital of YingDe City Guangdong Province, Yingde City, China
| | - Fanyu Wu
- Department of Orthopedics, People's Hospital of YingDe City Guangdong Province, Yingde City, China
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Effect of Electroacupuncture at The Zusanli Point (Stomach-36) on Dorsal Random Pattern Skin Flap Survival in a Rat Model. Dermatol Surg 2017; 43:1213-1220. [PMID: 28445199 DOI: 10.1097/dss.0000000000001178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Random skin flaps are commonly used for wound repair and reconstruction. Electroacupuncture at The Zusanli point could enhance microcirculation and blood perfusion in random skin flaps. OBJECTIVE To determine whether electroacupuncture at The Zusanli point can improve the survival of random skin flaps in a rat model. MATERIALS AND METHODS Thirty-six male Sprague Dawley rats were randomly divided into 3 groups: control group (no electroacupuncture), Group A (electroacupuncture at a nonacupoint near The Zusanli point), and Group B (electroacupuncture at The Zusanli point). McFarlane flaps were established. On postoperative Day 2, malondialdehyde (MDA) and superoxide dismutase were detected. The flap survival rate was evaluated, inflammation was examined in hematoxylin and eosin-stained slices, and the expression of vascular endothelial growth factor (VEGF) was measured immunohistochemically on Day 7. RESULTS The mean survival area of the flaps in Group B was significantly larger than that in the control group and Group A. Superoxide dismutase activity and VEGF expression level were significantly higher in Group B than those in the control group and Group A, whereas MDA and inflammation levels in Group B were significantly lower than those in the other 2 groups. CONCLUSION Electroacupuncture at The Zusanli point can effectively improve the random flap survival.
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Haktanır NT, Yılmaz G, Bozkurt MF, Demir Y. Effects of insulin-like growth factor-1 on random pattern skin flap survival in rats. Acta Cir Bras 2016; 31:513-9. [PMID: 27579878 DOI: 10.1590/s0102-865020160080000003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/11/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. METHODS Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. RESULTS Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. There was no significant histological difference between groups. CONCLUSION Although a single injection of insulin-like growth factor-1 (IGF-1) did not significantly increase flap survival, its wound healing features are still encouraging and further meticulously planned studies, especially with repeated applications or controlled-release methods, and combinations with binding protein are required.
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Affiliation(s)
- Nurten Turhan Haktanır
- Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ordu University, Turkey. Scientific, intellectual, conception and design of the study; manuscript preparation and writing; final approval
| | - Güray Yılmaz
- MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Unye State Hospital, Ordu, Turkey. Acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Mehmet Fatih Bozkurt
- Associate Professor, Department of Pathology, Faculty of Veterinary Medicine, Afyon Kocatepe University, Turkey. Histopathological examinations
| | - Yavuz Demir
- Full Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Mersin University, Turkey. Critical revision
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Lv QB, Gao X, Lin DS, Chen Y, Cao B, Zhou KL. Effects of diammonium glycyrrhizinate on random skin flap survival in rats: An experimental study. Biomed Rep 2016; 5:383-389. [PMID: 27588181 DOI: 10.3892/br.2016.733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/15/2016] [Indexed: 12/21/2022] Open
Abstract
Partial necrosis of skin flaps continues to restrict the survival of local skin flaps following plastic and reconstructive surgeries. The aim of the present study was to investigate the effects of diammonium glycyrrhizinate (DG), a salt of glycyrrhetinic acid that has been widely used in the therapy of chronic hepatitis and human immunodeficiency virus infection, on random skin flap survival in rats. McFarlane flaps were established in 60 male Sprague-Dawley rats randomly divided into three groups. Group I served as the control group and was injected with saline (10 mg/kg) once per day. Group II and group III were the experimental groups, and were injected with 10 mg/kg DG once and twice per day, respectively. On day 7, the survival area of the flap was measured. Tissue samples were stained with hematoxylin and eosin and immunohistochemically evaluated. Tissue edema, neutrophil density, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were evaluated. The mean survival areas of the flaps of group II were significantly larger when compared with those of group I (P<0.05), and the rats of group III exhibited significantly higher survival areas than group II (P<0.05). Histologic and immunohistochemical evaluation showed that microvessel development and the expression level of vascular endothelial growth factor were higher in the two experimental groups than in the control group. Furthermore, SOD activity was significantly increased (P<0.05), while the neutrophil density and MDA level were significantly reduced (P<0.05) in group II when compared with group I. Significant differences between group II and group III with regard to SOD activity and MDA level were also observed (P<0.05). Thus, DG may have a dose-dependent effect on promoting the survival of random skin flaps.
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Affiliation(s)
- Qing-Bo Lv
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Xiang Gao
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Ding-Sheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Yun Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Bin Cao
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Kai-Liang Zhou
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
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Temiz G, Yeşiloğlu N, Şirinoğlu H, Akpınar AC, Sarıcı M, Filinte D, Filinte GT, Bozkurt M. Increasing the survival of transverse rectus abdominis musculocutaneous flaps with a Botulinum toxin-A injection: A comparison of surgical and chemical flap delay methods. J Plast Reconstr Aesthet Surg 2016; 69:944-51. [DOI: 10.1016/j.bjps.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/07/2016] [Accepted: 02/10/2016] [Indexed: 12/30/2022]
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Comparison of Laser Doppler and Laser-Assisted Indocyanine Green Angiography Prediction of Flap Survival in a Novel Modification of the McFarlane Flap. Ann Plast Surg 2016; 75:102-7. [PMID: 24401807 DOI: 10.1097/sap.0000000000000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The McFarlane rat ischemic dorsal skin flap model has been commonly used for clinical vector studies, as well as the testing of noninvasive diagnostics. However, variability of this model secondary to flap contact with the wound bed has led many to question its validity. Here we present a novel modification to the McFarlane skin flap using sterile silicone. We also use this model to test the prognostic efficacy of laser-assisted indocyanine green (ICG) angiography and laser Doppler imaging (LDI). METHODOLOGY A 3 × 9-cm dorsal skin flap with a cranially based pedicle was created, centered 1 cm distal to the scapulae. The flap was undermined, and in one of the 2 groups, a sterile silicone sheet was placed onto the wound bed. All flaps were then reapproximated with sutures 1-cm intervals. Clinical assessment and perfusion imaging was performed immediately postoperative, and at 24, 48, and 72 hours postsurgery. Postoperative day 7 clinical assessment was obtained before euthanasia. RESULTS A comparative study using silicone blocked versus unblocked models (n = 6 per group) showed that, clinically, both models had equivalent flap survival [8.5 (0.913) vs 9.5 (1.01) cm]. However, a statistically significant increase in perfusion in the mid-third of unblocked models was observed on POD3 [20.28% (2.7%) vs blocked 13.45% (2.5%), P < 0.05], with a similar increase in the distal third on POD7 [18.73% (2.064%) vs 10.91% (4.19%), P < 0.05]. A prognostic study comparing LDI and ICG angiography prediction of POD7 survival at early time points (n = 10) found that LDI underpredicted flap survival at early time points [84.2% (12.03%) on POD0, 87.35% (16.11%) on POD1]. In contrast, ICG was more proficient [100.1% (10.1%) on POD0]. CONCLUSIONS We present a modification of the McFarlane skin flap model that results in similar clinical results, but with a noted reduction in perfusion inconsistencies noted in unblocked models. The ICG angiography is superior to LDI in predicting POD7 flap necrosis within the first 48 hours postinjury. Future work will focus on histologic validation of our model, and vector efficacy testing.
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20
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Klarik Z, Tamas R, Toth E, Kiss F, Kovacs EL, Jäckel M, Furka I, Nemeth N. Intra and postoperative evaluations of microcirculation and micro-rheological parameters in a rat model of musculocutaneous flap ischemia-reperfusion. Acta Cir Bras 2016; 30:551-60. [PMID: 26352335 DOI: 10.1590/s0102-865020150080000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To examine how the ischemia-reperfusion injury of latissimus dorsi-cutaneous maximus (LDCM) musculocutaneous flap affects the microcirculatory (flap's skin surface) and hemorheological parameters, and whether an intraoperative deterioration would predictively suggest flap failure in the postoperative period. METHODS Ten healthy male rats were subjected to the study. In Group I the left flap was sutured back after 2-hour, while the contralateral side was right after its elevation. In Group II the same technique was applied, but the pedicle of the left flap was atraumatically clamped for 2-hour. The contralateral side was left intact. On the flap skin surface laser Doppler tissue flowmetry measurements were done before and after and during the protocols applied in the groups. Microcirculatory and hemorheological examinations were done postoperatively. RESULTS The microcirculatory parameters significantly decreased during immobilization and ischemia. Afterwards, all the regions showed normalization. In the retrospective analysis there was a prominent difference between the microcirculatory parameters of necrotic and survived flap during the early postoperative days (1-3) in Group II. Erythrocyte aggregation and deformability showed only slight differences. CONCLUSIONS Two-hour ischemia and reperfusion caused deterioration in latissimus dorsi-cutaneous maximus flap microcirculation. Predicting the possible postoperative complication, the intraoperative laser Doppler measurement can be informative.
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Affiliation(s)
- Zoltan Klarik
- Institute of Surgery, Faculty of Medicine, University of Debrecen, HU
| | - Robert Tamas
- Department of Plastic and Burn Surgery, Medical Centre, Hungarian Defense Forces, Budapest, HU
| | - Eniko Toth
- Faculty of Medicine, University of Debrecen, HU
| | - Ferenc Kiss
- Faculty of Medicine, University of Debrecen, HU
| | | | - Marta Jäckel
- Medical Centre, Hungarian Defense Forces, Budapest, HU
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The Effects of Botulinum Toxin A on Survival of Rat TRAM Flap With Vertical Midline Scar. Ann Plast Surg 2015; 74:100-6. [DOI: 10.1097/sap.0b013e31828d706f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Cook DA, Thomson MJ. Complications of the angularis oris axial pattern buccal flap for reconstruction of palatine defects in two dogs. Aust Vet J 2014; 92:156-60. [PMID: 24766045 DOI: 10.1111/avj.12175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Abstract
CASE REPORT Complications associated with surgical reconstruction of hard palate defects with a buccal mucosal flap based on the angularis oris artery and vein in two dogs are described. Distal flap necrosis occurred in both cases, but the flaps were successfully salvaged by division of the original flap pedicle and rotation of the flap material into the remaining defect. Postoperative dysphagia was observed in both dogs until flap revision. Salvage of the intact distal portion of the flap following division of the direct artery and vein 14 days postoperatively is discussed. CONCLUSION The angularis oris axial pattern buccal flap is an option for reconstruction of large defects of the hard palate. Survival of the flap can be improved by removal of teeth likely to cause occlusal trauma to the flap's pedicle. In the event of distal flap necrosis, the repair may be salvaged by rotation of the remaining flap into the defect, following establishment of vascular supply from adjacent tissue.
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Affiliation(s)
- D A Cook
- Veterinary Specialist Services, The Springwood Centre, Corner Logan and Lexington Roads, Underwood, Queensland, 4119, Australia.
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Eggers C, Müller J, Schultze-Mosgau S. VEGF transfer based on gene-modified fibroblasts using a hypoxia-induced vector to modulate neoangiogenesis in ischaemic regions of myocutaneous transplants. Int J Oral Maxillofac Surg 2014; 44:267-76. [PMID: 25441860 DOI: 10.1016/j.ijom.2014.06.018] [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] [Received: 08/14/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Abstract
The effect of a hypoxia-inducible VEGF-expressing on wound healing in an ischaemic hind leg rat model was evaluated in this study. 180 Wistar rats were assigned randomly to three groups. After ligation of the femoral artery, group 1 received pRTP801-VEGF165, group 2 untransfected fibroblasts, group 3 saline; injection was into the subcutaneous tissue, proximal and distal to the artery ligation. Biopsy specimens were obtained on days 3, 5, 7, 14 after implementation. VEGF transgene expression, vessel architecture, the amount and total area of vessel formation were investigated. Results showed a significantly higher level of VEGF protein expression in group 1 compared to group 2 (P≤0.001) throughout the investigational period. Group 1 exhibited a significant growth of CD31-positive blood vessels in the subcutaneous tissue on day 14 compared to groups 2 and 3 (P≤0.001) (group 1, 62.20±1.92; group 2, 20.60±1.67; group 3, 12.40±1.14). Alpha-SMA-positive staining also showed significant vessel growth in group 1 on day 5 (group 1, 27.00±1.87; group 2, 7.20±1.48; group 3, 10.00±1.73). These results were confirmed in the distal muscle tissue. No significant results were obtained for the proximal muscle tissue. The subcutaneous application of pRTP801-VEGF165 showed a long-lasting effect, with an increased expression of VEGF over the entire observation period. It appears that the use of fibroblasts transfected with VEGF is a promising way to increase early angiogenesis in ischaemic tissue.
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Affiliation(s)
- C Eggers
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany.
| | - J Müller
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
| | - S Schultze-Mosgau
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
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Effects of traditional Chinese medicine Shuxuetong injection on random skin flap survival in rats. ScientificWorldJournal 2014; 2014:816545. [PMID: 24723830 PMCID: PMC3958672 DOI: 10.1155/2014/816545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/23/2014] [Indexed: 12/15/2022] Open
Abstract
Background. A Shuxuetong injection is traditionally used in Chinese medicine to treat “blood stasis and stagnation” (yu xue yu zhi). We investigated the effect of such injection on the survival of random skin flaps. Methods. McFarlane flaps were established in 60 rats divided into two groups. Postoperative celiac injections were given to both groups for 7 days. Shuxuetong was injected into the test group, and saline was injected into controls. On day 7, tissues were stained with H&E (hematoxylin-eosin) stain, immunohistochemically evaluated, and the expression levels of xanthine oxidase were determined. Result. The mean area of flap survival in the test group was significantly higher than in controls. Expression of vascular endothelial growth factor and superoxide dismutase, and microvessel development, were markedly increased in the test group, and the malondialdehyde level was reduced. Conclusion. Shuxuetong promotes random skin flap survival.
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Lateral gastrocnemius myocutaneous flap transposition to the midlateral femur: extending the arc of rotation. Ann Plast Surg 2014; 72 Suppl 1:S2-5. [PMID: 24401809 DOI: 10.1097/01.sap.0000435799.96674.9f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.
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Yildiz K, Karsidag S, Akcal A, Yesiloglu N, Ugurlu K, Ozagari A, Guneren E, Bas L. Comparison of the flap survival with ischemic preconditioning on different pedicles under varied ischemic intervals in a rat bilateral pedicled flap model. Microsurgery 2013; 34:129-35. [DOI: 10.1002/micr.22192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/19/2013] [Accepted: 09/04/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Kemalettin Yildiz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Medical School; Bezmialem Vakıf University; Istanbul Turkey
| | - Semra Karsidag
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Arzu Akcal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Nebil Yesiloglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Kemal Ugurlu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Aysim Ozagari
- Department of Pathology, Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Medical School; Bezmialem Vakıf University; Istanbul Turkey
| | - Lutfu Bas
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital; Istanbul Turkey
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Wang X, Li C, Zheng Y, Xia W, Yu Y, Ma X. Bone marrow mesenchymal stem cells increase skin regeneration efficiency in skin and soft tissue expansion. Expert Opin Biol Ther 2012; 12:1129-39. [PMID: 22762256 DOI: 10.1517/14712598.2012.704016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Skin and soft tissue expansion has limitations such as long hospitalization time and flap retraction after expansion. Our previous study suggested that bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion. In this study, the authors explored the feasibility of applying the bone marrow mesenchymal stem cells (BMMSCs) to the treatment of skin and soft tissue expansion and increasing the skin regeneration efficiency. METHODS Sixty silicone expanders were implanted in the backs of 15 pigs, and allogeneic BMMSCs were transplanted to skin shallow fascia layer (local transplantation, Group A) or via ear vein (systemic transplantation, Group B). Group C was the Sham operation control; and then the expanders were injected with normal saline (N.S.). Skin was obtained at different time points (days 0, 14, 21, 28, 35, and 42). The organizational structure changes of the target skin were observed in the expansion process. The distribution, differentiation, and paracrine function of labeled BMMSCs were detected. RESULTS Comparing with Group B (25.00 ± 1.98 cm(2)) or Group C (24.00 ± 1.10 cm(2), no transplantation), the expanded skin area of Group A (28.82 ± 1.43 cm(2)) increased, with the morphology of epidermis thickened, and dermis thinned. The BMMSCs differentiated into vascular endothelial cells and dermal fibroblasts. The quantity of newborn cells was proportional to the number of transplanted cells. The gene expression of VEGF, bFGF, EGF, and SDF in Group A was higher than those in Group B or C. The most obvious changes were on day 35. CONCLUSIONS The local transplanted BMMSCs could increase the skin regeneration efficiency in skin and soft tissue expansion and reduce skin shrinkage effectively after removing the expander. Growth factors, VEGF, bFGF, EGF, and SDF, are favorable to this process.
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Affiliation(s)
- Xiaoyan Wang
- Xijing Hospital of Fourth Military Medical University, Department of Plastic Surgery , 15 West Changle Road, Xi'an, Shanxi Province 710032, PR China
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