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Alfotawi R. Assessment of Novel Surgical Procedures Using Bone Morphogenic Protein-7 Infused Into Decellularised Muscle and Bioactive Ceramic: A Histological Analysis. J Craniofac Surg 2024:00001665-990000000-01810. [PMID: 39141821 DOI: 10.1097/scs.0000000000010507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE Reconstruction of critical bone defects is considered a challenge due to vascular reperfusion injury that may occur. The present study hypothesized that the use of decellularized muscle scaffold (DMS) and bone morphogenic protein-7 (BMP-7), along with resorbable bioactive ceramic silica calcium phosphate cement (SCPC) seeded with human bone marrow stromal cells, can expedite bone formation and maturation. METHODS Surgical bone defects were created in 20 nude transgenic mice. In experimental group 1 (n = 10), a critical-size (4 mm) calvarial defect was made and grafted with DMS-BMP-7/SCPC. In situ human bone marrow stromal cells [human mesenchymal stromal cells (hMSC)] were seeded thereafter. As a control, group 2 (n = 10) was treated with DMS/SCPC seeded with hMSCs. After 8 weeks, bone regeneration was evaluated using histology and histomorphometry for both groups. RESULTS Histological examination showed bone regeneration crossing the gap (experimental group 1), bone regeneration was noted at the defect periphery, and scattered islands of bone at the canters of the defects (control group 2). New bone formation and maturation were superior in the groups treated with the DMS/BMP-7/SCPC/hMSC constructs. The quantitative histological assessment revealed that the average bone surface area was 255 ± 25 mm2, which was 1.5 times the surface area of group 2, which was reported at 170 ± 35 mm2. The reported difference was considered statistically significant (P < 0.05). CONCLUSION The DMS-BMP-7/SCPC scaffold induced bone regeneration and neovascularization in critical-size defects.
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Affiliation(s)
- Randa Alfotawi
- Department of Oral and Maxillofacial, Dental Collage, King Saud University, Riyadh, Kingdom of Saudia Arabia
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2
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Khalaf R, Duarte Bateman D, Reyes J, Najafali D, Rampazzo A, Bassiri Gharb B. Systematic review of pathologic markers in skin ischemia with and without reperfusion injury in microsurgical reconstruction: Biomarker alterations precede histological structure changes. Microsurgery 2024; 44:e31141. [PMID: 38361264 DOI: 10.1002/micr.31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Ischemia and ischemia-reperfusion injury contribute to partial or complete flap necrosis. Traditionally, skin histology has been used to evaluate morphological and structural changes, however histology does not detect early changes. We hypothesize that morphological and structural skin changes in response to ischemia and IRI occur late, and modification of gene and protein expression are the earliest changes in ischemia and IRI. METHODS A systematic review was performed in accordance with PRISMA guidelines. Studies reporting skin histology or gene/protein expression changes following ischemia with or without reperfusion injury published between 2002 and 2022 were included. The primary outcomes were descriptive and semi-quantitative histological structural changes, leukocyte infiltration, edema, vessel density; secondary outcomes were quantitative gene and protein expression intensity (PCR and western blot). Model type, experimental intervention, ischemia method and duration, reperfusion duration, biopsy location and time point were collected. RESULTS One hundred and one articles were included. Hematoxylin and eosin (H&E) showed inflammatory infiltration in early responses (12-24 h), with structural modifications (3-14 days) and neovascularization (5-14 days) as delayed responses. Immunohistochemistry (IHC) identified angiogenesis (CD31, CD34), apoptosis (TUNEL, caspase-3, Bax/Bcl-2), and protein localization (NF-κB). Gene (PCR) and protein expression (western blot) detected inflammation and apoptosis; endoplasmic reticulum stress/oxidative stress and hypoxia; and neovascularization. The most common markers were TNF-α, IL-6 and IL-1β (inflammation), caspase-3 (apoptosis), VEGF (neovascularization), and HIF-1α (hypoxia). CONCLUSION There is no consensus or standard for reporting skin injury during ischemia and IRI. H&E histology is most frequently performed but is primarily descriptive and lacks sensitivity for early skin injury. Immunohistochemistry and gene/protein expression reveal immediate and quantitative cellular responses to skin ischemia and IRI. Future research is needed towards a universally-accepted skin injury scoring system.
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Affiliation(s)
- Ryan Khalaf
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jose Reyes
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Najafali
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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3
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Deng Z, Long ZS, Chen G. Mini-Review: Tendon-Exposed Wound Treatments. J INVEST SURG 2023; 36:2266758. [PMID: 37813390 DOI: 10.1080/08941939.2023.2266758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Tendon-exposed wounds are complex injuries with challenging reconstructions and no unified treatment mode. Furthermore, insufficient tissue volume and blood circulation disorders affect healing, which increases pain for the patient and affects their families and caretakers. REVIEW As modern medicine advances, considerable progress has been made in understanding and treating tendon-exposed wounds, and current research encompasses both macro-and micro-studies. Additionally, new treatment methods have emerged alongside the classic surgical methods, such as new dressing therapies, vacuum sealing drainage combination therapy, platelet-rich plasma therapy, and live-cell bioengineering. CONCLUSIONS This review summarizes the latest treatment methods for tendon-exposed wounds to provide ideas and improve their treatment.
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Affiliation(s)
- Zhuan Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhi-Sheng Long
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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4
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Raj M, Bhartiya RK, Rajput AK, Singh SK, Jadon JPS, Gill SPS. Hyperbaric Oxygen Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma: A Prospective Study. Cureus 2023; 15:e48848. [PMID: 38106741 PMCID: PMC10723627 DOI: 10.7759/cureus.48848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Non-union, chronic pain, functional disability, and infection are all things that have been associated with open fractures with severe soft tissue damage leading to the need for additional hospitalization, and sometimes even subsequent surgeries and weeks or months of rehabilitation. Open fractures and severe musculoskeletal injuries are occasionally treated with hyperbaric oxygen therapy (HBOT) in an effort to reduce the risk of complications and increase the likelihood of a successful recovery. Methods A prospective randomized controlled study was done between January 2019 and August 2022 at a tertiary health care center including 60 patients with a severe soft tissue injury (Grade II and III) divided into two groups - group-CT (30 patients who received conventional treatment) and group HT (30 patients, who received HBOT in addition to conventional treatment). The outcome was measured according to the Bates-Jensen Wound Assessment Tool. Results The wound size, depth, and granulation were significantly reduced in group-HT patients. In the final session, the patient's severity of the wound in group-HT was significantly reduced (P = 0.0001) compared to group-CT. Conclusions Patients who received HBOT reported a significant improvement in their wounds.
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Affiliation(s)
- Manish Raj
- Orthopedics, AIIMS Deoghar, Deoghar, IND
| | - Raj K Bhartiya
- Orthopedics and Traumatology, Maa Vindhyawasini Autonomous State Medical College, Mirzapur, IND
| | - Ajay K Rajput
- Orthopedics, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Santosh Kumar Singh
- Orthopedics and Traumatology, Maa Vindhyawasini Autonomous State Medical College, Mirzapur, IND
| | | | - S P S Gill
- Orthopedics, Uttar Pradesh University of Medical Sciences, Etawah, IND
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5
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Al-Fotawi R, Fallatah W. Revascularization and angiogenesis for bone bioengineering in the craniofacial region: a review. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:30. [PMID: 37249725 DOI: 10.1007/s10856-023-06730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/17/2023] [Indexed: 05/31/2023]
Abstract
The revascularization of grafted tissues is a complicated and non-straightforward process, which makes it challenging to perform reconstructive surgery for critical-sized bone defects. This challenge is combined with the low vascularity that results from radiotherapy. This low vascularity could result from ischemia-reperfusion injuries, also known as ischemia which may happen upon grafting. Ischemia may affect the hard tissue during reconstruction, and this can often cause resorption, infections, disfigurement, and malunion. This paper therefore reviews the clinical and experimental application of procedures that were employed to improve the reconstructive surgery process, which would ensure that the vascularity of the tissue is maintained or enhanced. It also presents the key strategies that are implemented to perform tissue engineering within the grafted sites aiming to optimize the microenvironment and to enhance the overall process of neovascularization and angiogenesis. This review reveals that the current strategies, according to the literature, are the seeding of the mature and progenitor cells, use of extracellular matrix (ECM), co-culturing of osteoblasts with the ECM, growth factors and the use of microcapillaries incorporated into the scaffold design. However, due to the unstable and regression-prone capillary structures in bone constructs, further research focusing on creating long-lasting and stable blood vessels is required.
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Affiliation(s)
- Randa Al-Fotawi
- Oral and Maxillofacial Dept. Dental Faculty, King Saud University, Riyadh, 11451, Saudi Arabia.
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6
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Lee JH, You HJ, Lee TY, Kang HJ. Current Status of Experimental Animal Skin Flap Models: Ischemic Preconditioning and Molecular Factors. Int J Mol Sci 2022; 23:5234. [PMID: 35563624 PMCID: PMC9103896 DOI: 10.3390/ijms23095234] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Skin flaps are necessary in plastic and reconstructive surgery for the removal of skin cancer, wounds, and ulcers. A skin flap is a portion of skin with its own blood supply that is partially separated from its original position and moved from one place to another. The use of skin flaps is often accompanied by cell necrosis or apoptosis due to ischemia-reperfusion (I/R) injury. Proinflammatory cytokines, such as nuclear factor kappa B (NF-κB), inhibitor of kappa B (IκB), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and oxygen free radicals are known causative agents of cell necrosis and apoptosis. To prevent I/R injury, many investigators have suggested the inhibition of proinflammatory cytokines, stem-cell therapies, and drug-based therapies. Ischemic preconditioning (IPC) is a strategy used to prevent I/R injury. IPC is an experimental technique that uses short-term repetition of occlusion and reperfusion to adapt the area to the loss of blood supply. IPC can prevent I/R injury by inhibiting proinflammatory cytokine activity. Various stem cell applications have been studied to facilitate flap survival and promote angiogenesis and vascularization in animal models. The possibility of constructing tissue engineered flaps has also been investigated. Although numerous animal studies have been published, clinical data with regard to IPC in flap reconstruction have never been reported. In this study, we present various experimental skin flap methods, IPC methods, and methods utilizing molecular factors associated with IPC.
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Affiliation(s)
- Ju-Hee Lee
- College of Korean Medicine, Dongguk University, Goyang 10326, Korea;
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University Ansan Hospital, Ansan 15355, Korea; (H.-J.Y.); (T.-Y.L.)
| | - Tae-Yul Lee
- Department of Plastic Surgery, Korea University Ansan Hospital, Ansan 15355, Korea; (H.-J.Y.); (T.-Y.L.)
| | - Hyo Jin Kang
- Biomedical Research Center, Korea University Ansan Hospital, Ansan 15355, Korea
- Core Research and Development Center, Korea University Ansan Hospital, Ansan 15355, Korea
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7
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Xi YQ, Xu LH, Yang LJ, Wang HQ, Yang TC, Li Z, Xie W, Zhang JW, Li XF, Feng MH. Overexpression of eRF3a Promotes Cell Proliferation and Migration in Liver Cancer. Curr Med Sci 2022; 42:100-107. [PMID: 34985612 DOI: 10.1007/s11596-021-2463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The eukaryotic release factor 3a (eRF3a), a member of the eukaryotic peptide chain release factor family, is overexpressed in several types of cancer. This study aims to investigate the biological role and mechanism of eRF3a in the progression of liver cancer. METHODS Western blotting and RT-qPCR were used to detect the expression level of eRF3a in normal liver cells and liver cancer cells. The cell transfection experiments were performed to overexpress eRF3a levels in liver cancer cells HCCLM9 and Huh7, and then cell cycle and apoptosis experiments, Cell Counting Kit-8 (CCK8), plate cloning, and Transwell experiments were done to evaluate the function of eRF3a in the progression of liver cancer. The Western blotting was done to explore the mechanism of eRF3a promoting the development of liver cancer. Western blotting and RT-qPCR were used to detect the expression level of eRF3a in normal liver cells and liver cancer cells. The cell transfection experiments were performed to overexpress eRF3a levels in liver cancer cells HCCLM9 and Huh7, and then cell cycle and apoptosis experiments, Cell Counting Kit-8 (CCK8), plate cloning, and Transwell experiments were done to evaluate the function of eRF3a in the progression of liver cancer. The Western blotting was done to explore the mechanism of eRF3a promoting the development of liver cancer. RESULTS eRF3a was significantly highly expressed in liver cancer cells, and its expression level was negatively correlated with the clinical prognosis of patients. In addition, in vitro experiments showed that eRF3a could promote the proliferation and migration of liver cancer cells through the ERK and JNK signaling pathways. CONCLUSION This study suggests that eRF3a may be a potential prognostic marker for liver cancer and act as an oncogene by activating JNK and ERK signaling; therefore, eRF3a may be a new target for the treatment of liver cancer.
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Affiliation(s)
- Yi-Qing Xi
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li-Hua Xu
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li-Jie Yang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hua-Qiao Wang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China.,Clinical Cancer Study Center of Hubei Province, Wuhan, 430071, China
| | - Tie-Cheng Yang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China.,Clinical Cancer Study Center of Hubei Province, Wuhan, 430071, China
| | - Zhi Li
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wei Xie
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China
| | - Jing-Wei Zhang
- Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China.,Clinical Cancer Study Center of Hubei Province, Wuhan, 430071, China
| | - Xuan-Fei Li
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China. .,Clinical Cancer Study Center of Hubei Province, Wuhan, 430071, China. .,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China.
| | - Mao-Hui Feng
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Wuhan, 430071, China. .,Clinical Cancer Study Center of Hubei Province, Wuhan, 430071, China. .,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China.
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8
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Lindenmann J, Smolle C, Kamolz LP, Smolle-Juettner FM, Graier WF. Survey of Molecular Mechanisms of Hyperbaric Oxygen in Tissue Repair. Int J Mol Sci 2021; 22:11754. [PMID: 34769182 PMCID: PMC8584249 DOI: 10.3390/ijms222111754] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023] Open
Abstract
For more than six decades, hyperbaric oxygen (HBO) has been used for a variety of indications involving tissue repair. These indications comprise a wide range of diseases ranging from intoxications to ischemia-reperfusion injury, crush syndrome, central nervous injury, radiation-induced tissue damage, burn injury and chronic wounds. In a systematic review, the molecular mechanisms triggered by HBO described within the last two decades were compiled. They cover a wide range of pathways, including transcription, cell-to-cell contacts, structure, adhesion and transmigration, vascular signaling and response to oxidative stress, apoptosis, autophagy and cell death, as well as inflammatory processes. By analyzing 71 predominantly experimental publications, we established an overview of the current concepts regarding the molecular mechanisms underlying the effects of HBO. We considered both the abovementioned pathways and their role in various applications and indications.
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Affiliation(s)
- Joerg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/3, 8036 Graz, Austria;
| | - Christian Smolle
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/2, 8036 Graz, Austria; (C.S.); (L.-P.K.)
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/2, 8036 Graz, Austria; (C.S.); (L.-P.K.)
| | - Freyja Maria Smolle-Juettner
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/3, 8036 Graz, Austria;
| | - Wolfgang F. Graier
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria;
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9
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Seyid M, Tiftikcioglu Y, Erdem M, Akdemir O, Tatar BE, Uyanıkgil Y, Ercan G. The Effect of Ceruloplasmin Against Ischemia-Reperfusion Injury in Epigastric Island Flap in Rats. J Surg Res 2021; 267:627-635. [PMID: 34273792 DOI: 10.1016/j.jss.2021.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Flap surgery is frequently used in plastic surgery to close tissue defects. Ischemia-reperfusion (I/R) injury is a significant problem resulting in partial or total flap necrosis. This study aimed to investigate the effect of ceruloplasmin on I/R injury in epigastric island flaps in rats. MATERIAL AND METHOD A total of 32 male Sprague-Dawley rats were divided into four groups with eight rats in each group: The flap was not elevated in Group I; the flap was elevated without ischemia or any application in Group II, after the intraperitoneal saline and ceruloplasmin application the flaps were elevated and ischemia was created in group III-IV, respectively. Bilateral epigastric artery flap was elevated in all groups except Group I. After 6 h of ischemia, the flap was reperfused and inset. Samples were taken from the right and left side of the flap area in other groups at the postoperative 24th h for biochemical analysis (catalase and malondialdehyde-MDA) and the seventh postoperative day for histopathological analysis (Modified Verhofstad score and epidermal thicknesses), respectively. Image analysis for necrosis areas was performed on photos taken on the 7th d. RESULTS Catalase level was significantly higher in Group IV.(0.15 ± 0.04 U/mg protein) (P < 0.05) Necrosis area percentage(14.4% ± 3.3%),MDA(3.6 ± 0.9 nmol/mg protein), edema(3), necrosis(2.75), and polymorphonuclear leukocyte infiltration(2.87) scores were significantly higher in group III.(P < 0.05). Fibroblast proliferation, collagen density (0.25), vascular density (0.25) scores and epidermal thickness (15.68 µm,) was significantly lower in group III. (P < 0.05) CONCLUSIONS: Our study demonstrated that ceruloplasmin application before ischemia reduced I/R injury in epigastric island flaps in rats.
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Affiliation(s)
- Mircafer Seyid
- Baku Medical Plaza, Department of Plastic Surgery, Baku, Azerbaijan.
| | - Yigit Tiftikcioglu
- Ege University Faculty of Medicine, Department of Plastic Surgery, Izmir, Turkey
| | - Mehmet Erdem
- University of Health Sciences, Bagcılar Training and Research Hospital, Department of Plastic Surgery, Istanbul, Turkey
| | - Ovunc Akdemir
- Esenyurt University, Department of Plastic Surgery, Istanbul, Turkey
| | - Burak Ergün Tatar
- University of Health Sciences, Bagcılar Training and Research Hospital, Department of Plastic Surgery
| | - Yigit Uyanıkgil
- Ege University Faculty of Medicine, Department of Histology and Embryology, Izmir, Turkey
| | - Gülinnaz Ercan
- Ege University Faculty of Medicine, Department of Biochemistry, Izmir Turkey
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10
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Kilic F, Eskitascioglu T, Aydin A, Cakici OU. Ameliorating Effects of β-Glucan on Epigastric Artery Island Flap Ischemia-Reperfusion Injury. J Surg Res 2021; 261:282-292. [PMID: 33477077 DOI: 10.1016/j.jss.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury has been one of the culprits of tissue injury and flap loss after island flap transpositions. Thus, significant research has been undertaken to study how to prevent or decrease the spread of ischemia-reperfusion injury. Preventive effects of β-glucan on ischemia-reperfusion injury in the kidney, lung, and small intestine have previously been reported. In this study, we present the ameliorating effects of β-glucan on ischemia-reperfusion injury using the epigastric artery island-flap in rats. MATERIALS AND METHODS Thirty Wistar-Albino rats were equally divided into three groups: sham, experimental model, and treatment groups. In the sham group, an island flap was elevated and sutured back to the original position without any ischemia. In the experimental model group, the same-sized flap was elevated and sutured back with 8 h of ischemia and consequent 12 h of reperfusion. In the treatment group, 50 mg per kilogram β-glucan was administered to the rats using an orogastric tube for 10 d before the experiment. The same-sized flap is elevated and sutured back to its original position with 8 h of ischemia and 12 h of consequent reperfusion in the treatment group. Tissue biopsies were taken on the first day of the experimental surgery. Tissue neutrophil aggregation and vascular responses were evaluated by histological examinations. Tissue oxidant and antioxidant enzyme levels are evaluated biochemically after tissue homogenization. Topographic follow-up and evaluation of the flaps were maintained, and photographs were taken on the first and seventh day of the experimental surgery. RESULTS Topographic flap survival was significantly better in the β-glucan administered group. The neutrophil number, malondialdehyde, and myeloperoxidase levels were significantly lower while glutathione peroxidase and superoxide dismutase levels were significantly higher in the β-glucan administered group respective to the experimental model group. CONCLUSIONS Based on the results of our study, we can conclude that β-glucan is protective against ischemia-reperfusion injury. Our study presents the first experimental evidence of such an effect on skin island flaps.
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Affiliation(s)
- Fatih Kilic
- Department of Aesthetic Plastic and Reconstructive Surgery, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Teoman Eskitascioglu
- Department of Aesthetic Plastic and Reconstructive Surgery, Memorial Hospital, Kayseri, Turkey
| | - Ahmet Aydin
- Department of Aesthetic Plastic and Reconstructive Surgery, Bagcilar Medipol Mega University Hospital, Istanbul, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Yuksek Ihtisas University, Ankara, Turkey.
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11
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Ma X, Lin Y, Liu Y, Li W, He J, Fang M, Lin D. Effects of Apigenin Treatment on Random Skin Flap Survival in Rats. Front Pharmacol 2021; 12:625733. [PMID: 33716750 PMCID: PMC7944095 DOI: 10.3389/fphar.2021.625733] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Random skin flaps are often used in plastic surgery, but the complications of marginal flap ischemia and necrosis often limit their wider clinical application. Apigenin (Api) is a flavonoid found in various fruits and vegetables. Api has been shown to promote angiogenesis, as well as reduce oxidative stress, membrane damage, and inflammation. In this study, we assessed the effects of Api treatment on random skin flap survival. Dorsal McFarlane skin flaps were transplanted into rats, which were randomly divided into three groups: control (normal saline), low-dose Api (20 mg/kg), and high-dose Api (50 mg/kg). Seven days after the surgery, the activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were measured. Histological analyses were performed to determine flap survival and tissue edema. H&E staining was performed to assess the histopathological changes in skin flaps, and the levels of microvascular density (MVD) were determined. Laser doppler flowmetry was used to assess microcirculation blood flow. Flap angiography was performed by injection of lead oxide/gelatin. The expression levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interlukin-1β (IL-lβ) were evaluated by immunohistochemistry. Rats in the high-dose Api group exhibited higher average flap survival area, microcirculatory flow, increased SOD activity, and higher VEGF expression levels compared with the other two groups. Furthermore, the levels of MDA and pro-inflammatory cytokines were significantly decreased in rats treated with high-dose Api. Our findings suggest the potential usefulness of Api in preventing skin flap tissue necrosis.
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Affiliation(s)
- Xinyi Ma
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Second College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Yuting Lin
- First College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Yingying Liu
- Second College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Wenjie Li
- Second College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Jibing He
- Second College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Miaojie Fang
- Second College of Clinical Medical, Wenzhou Medical University, Wenzhou, China
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Irvine LE, Azizzadeh B, Kerulos JL, Nassif PS. Outcomes of a Treatment Protocol for Compromised Nasal Skin in Primary and Revision Open Rhinoplasty. Facial Plast Surg Aesthet Med 2020; 23:118-125. [PMID: 33054380 DOI: 10.1089/fpsam.2020.0181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: This is the first study to review the incidence of nasal skin compromise after open rhinoplasty surgery and outcomes of treatment. Objectives: To determine whether risk of skin compromise after open rhinoplasty surgery can be predicted and whether our treatment protocol led to acceptable outcomes. Design, Setting, and Participants: This is a retrospective chart review of the senior author's private patients. In total, 384 rhinoplasty cases were reviewed and all cases with signs of vascular compromise requiring treatment were analyzed. Main Outcomes and Measures: Descriptive statistics were used to evaluate characteristics of patients who developed intra- and postoperative skin compromise, and unpaired two-tailed t-test was used to compare the characteristics of patients with and without compromised nasal skin when possible. Overall satisfaction results and complications in the skin compromise group were reported. Results: A total of 384 open rhinoplasties were performed by the senior author between October 1, 2015, and December 31, 2018. Of them, 109 were primary rhinoplasties and 275 were revision rhinoplasties. Of the 384 rhinoplasties, 27 (7%) had skin compromise leading to unplanned postoperative treatment. Two of the patients in the skin compromise group underwent primary surgeries (7.4%) and 25 underwent revision procedures (92.6%). Advanced age (p < 0.0001), prior or current history of smoking (p = 0.027), and greater number of prior rhinoplasty surgeries (p = 0.0002) were significantly correlated with risk of skin compromise. The average time to last follow-up in the skin compromise group was 392 days (range 15-1057 days). At their last follow-up, 12 patients had complete resolution of all signs of nasal skin compromise with no further treatment required (44.4%). The revision rate for patients experiencing skin compromise was 22.2%. One patient underwent revision surgery directly related to a complication of skin compromise and one is considering revision directly related to skin breakdown. Conclusions and Relevance: The rate of skin compromise after open rhinoplasty is low. Older patients and patients with more prior rhinoplasty surgeries may be at increased risk. Prompt treatment of compromised nasal blood supply after rhinoplasty surgery can salvage skin in most patients.
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Affiliation(s)
| | - Babak Azizzadeh
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.,Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
| | - Julia L Kerulos
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago-College of Medicine, Chicago, Illinois, USA
| | - Paul S Nassif
- Nassif MD, Inc., and Associates, Beverly Hills, California, USA.,Department of Head and Neck Surgery, Keck School of Medicine at the University of Southern California, Los angeles, California, USA
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Alfotawi R. An Update in Reconstructive Surgery. J INVEST SURG 2020; 34:1377-1378. [PMID: 32799704 DOI: 10.1080/08941939.2020.1806961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Randa Alfotawi
- Department of Oral and Maxillofacial Surgery, King Khalid University Hospital, Faculty of Dentistry, King Saud University, Riyadh, KSA
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Pak CS, Moon SY, Lee YE, Kang HJ. Therapeutic Effects against Tissue Necrosis of Remote Ischemic Preconditioning Combined with Human Adipose-Derived Stem Cells in Random-Pattern Skin Flap Rat Models. J INVEST SURG 2020; 34:1304-1311. [PMID: 32691637 DOI: 10.1080/08941939.2020.1795750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Remote ischemic preconditioning (rIPC) is a preventive strategy against ischemia-reperfusion injury. To reduce ischemia-reperfusion injury of random-pattern skin flaps, we investigated the therapeutic effects of rIPC combined with human adipose-derived stem cells (hADSCs) in a rat model. MATERIAL AND METHODS In total, 24 female Sprague Dawley rats were divided into four groups (n = 6 each): control (skin flap only), rIPC, hADSCs, and rIPC + hADSCs. rIPC was performed in the hind limb of the rats over three cycles of 5 min of occlusion and 5 min of reperfusion, using a tourniquet. A rectangular (3 × 9 cm) dorsal skin flap was used. hADSCs (5 × 105 cells/100 µL) labeled with fluorescent dye were transplanted into the normal subcutaneous tissue at the skin flap boundary. After 14 days, the therapeutic effects of rIPC and hADSCs were evaluated via analysis of the necrotic flap area, histopathologic assessment, and immunohistochemistry (von Willebrand Factor (vWF) and CD31). RESULTS The necrotic area of the skin flap significantly decreased in the rIPC + hADSCs group (32.75 ± 1.43%) compared with the control (40.60 ± 3.27%, P < 0.01) and rIPC groups (38.84 ± 0.77%, P < 0.05). Dye-labeled hADSCs migrated to the skin flap from the injection site. In the rIPC + hADSCs group, the epithelial tissue and skin appendage had regenerated, and the smooth muscle and subcutaneous fat layers were preserved. Many more vWF- and CD31-positive vessels were observed in the rIPC + hADSCs group compared with the other groups. CONCLUSIONS The rIPC + hADSCs treatment appeared to reduce skin flap necrosis and activated neovascularization in rats. Therefore, it may be a good strategy for clinical treatment of ischemia-reperfusion injury.
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Affiliation(s)
- Chang Sik Pak
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea.,Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Young Moon
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Korea
| | - Young Eun Lee
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jin Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea.,Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Korea
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Neheman A, Rappaport YH, Verhovsky G, Bush N, Snodgrass W, Lang E, Zisman A, Efrati S. Hyperbaric oxygen therapy for pediatric "hypospadias cripple"-evaluating the advantages regarding graft take. J Pediatr Urol 2020; 16:163.e1-163.e7. [PMID: 32171667 DOI: 10.1016/j.jpurol.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hypospadias cripple patients pose a major surgical challenge with high complication rates attributed mainly to graft contraction. Hyperbaric oxygen therapy (HBOT) is an established treatment for compromised grafts and used extensively as a salvage therapy for compromised grafts and ischemic non-healing wounds. OBJECTIVE We evaluated the graft-take rates in hypospadias cripple cases undergoing a staged tubularized autograft repair (STAG) and compared between patients treated with or without preemptive HBOT. MATERIALS AND METHODS All patients underwent a STAG. Patients receiving preemptive HBOT were compared with patients receiving the standard surgical procedure without HBOT. The HBOT protocol included a daily session, 5 days per week for four weeks before the surgery and 10 additional daily sessions immediately after first-stage surgery. Each HBOT session included 90 min exposure to 100% O2 at 2 atmospheres absolute with 5 min air breaks every 20 min. The primary endpoint was graft take. Sequential tubularization without tension at second stage was defined as success. RESULTS Seven boys received HBOT and 14 boys comprised the control group. All patients in the HBOT group had good graft take with no graft contraction. In the control group, 57% had good graft take and could proceed to the second-stage surgery and 43% had graft contraction (Table). Except for one patient who had claustrophobia while entering the chamber, no significant side-effects developed during the HBOT. DISCUSSION The basic pathophysiology of compromised flaps includes both ischemia and reperfusion injury, which can be attenuated by HBOT. The beneficial effects of HBOT relates to several mechanisms, including hyperoxygenation, fibroblast proliferation, collagen deposition, angiogenesis, and vasculogenesis. Graft contraction is a well-known complication in hypospadias cripple population with reported failure rate of 39-63%. The HBOT procedure was found to be very effective and the entire HBOT group had a good graft take. Accordingly, all patients in the HBOT group proceeded to a successful second-stage tubularization. In addition, HBOT was found to be safe and generally well tolerated by this pediatric population. Study limitations were a relative small, non-homogenous sample size and lack of prospective randomization. Success was defined as sufficient graft elasticity sufficing for tubularization of the neourethra, and exact graft measurements are lacking in this study. CONCLUSIONS Preemptive HBOT can be used safely in the hypospadias cripple pediatric population and can potentially reduce the expected high surgical failure secondary to graft contraction.
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Affiliation(s)
- Amos Neheman
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai H Rappaport
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Guy Verhovsky
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | | | | | - Erez Lang
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mao Y, Chen X, Xia Y, Xie X. Repair Effects of KGF on Ischemia-Reperfusion–Induced Flap Injury via Activating Nrf2 Signaling. J Surg Res 2019; 244:547-557. [DOI: 10.1016/j.jss.2019.06.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 06/19/2019] [Indexed: 01/12/2023]
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Hyperbaric Oxygen Preconditioning Can Reduce Postabdominoplasty Complications: A Retrospective Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2417. [PMID: 31772875 PMCID: PMC6846320 DOI: 10.1097/gox.0000000000002417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Hyperbaric oxygen therapy (HBOT) can improve wound healing and has been found to have positive preconditioning effects in animal models. Among esthetic surgical procedures, abdominoplasty poses the highest rate of postoperative complications. The aim of this study was to evaluate the effect of preoperative HBOT as a preconditioning treatment for expected postsurgical complications.
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18
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Farrokhi M, Gashti MZ, Hoormand M, Bakhtiarian A, Habibi R. Combination therapy profoundly improved skin flap survival by modulating KATP channels and nitric oxide. Adv Med Sci 2019; 64:117-123. [PMID: 30640077 DOI: 10.1016/j.advms.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE A potential therapeutic approach on skin flap necrosis is to target parallel pathways involved in necrosis. Azelaic Acid, Minoxidil and Caffeine combination was tried on skin flap survival by their possible interaction with ATP sensitive potassium (KATP) channels and nitric oxide pathway. MATERIAL AND METHODS Sprauge-Dawley rats were divided into 8 groups for skin flap surgery. Azelaic acid, minoxidil, caffeine, or their combination were applied topically in different groups. Two additional groups were treated with L-NAME or glibenclamide in addition to the combination therapy. Percentage of flap necrosis was calculated and flap samples were removed to measure tissue malondialdehyde (MDA) and nitric oxide (NO) and expression of inducible nitric oxide synthase (iNOS), Bcl-2 and Bax proteins. RESULTS Combination therapy profoundly decreased skin flap necrosis, tissue MDA contents, and expression of the pro-apoptotic protein Bax (p < 0.05 vs. single treatments). These effects were reversed by L-NAME and glibenclamide pre-treatments. Further evaluations showed combination therapy increases flap tissue NO content and iNOS expression (p < 0.05 vs. single treatments). CONCLUSION Beneficial effect of the combination therapy with azelaic acid, minoxidil and caffeine therapy on rescuing the flap from necrosis by targeting parallel signaling pathways suggested potential applications in clinical practice.
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Affiliation(s)
- Mahtab Farrokhi
- Department of Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Hoormand
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azam Bakhtiarian
- Department of Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Rohalah Habibi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Zhao G, Zhang X, Xu P, Mi JY, Rui YJ. The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats. Injury 2018; 49:2147-2153. [PMID: 30293870 DOI: 10.1016/j.injury.2018.09.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats. METHODS A total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of "choke vessels" was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day. RESULTS On the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001). CONCLUSION Irisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.
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Affiliation(s)
- Gang Zhao
- Soochow University, Soochow, Jiangsu, China; Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Xin Zhang
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Peng Xu
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Jing-Yi Mi
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Yong-Jun Rui
- Soochow University, Soochow, Jiangsu, China; Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China.
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20
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Zhang J, Yu Q, Liu Y, Liu H, Sun M, Tian Q, Tu S. [Propofol combined with hypoxia induces cognitive dysfunction in immature rats via p38 pathway]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1294-1299. [PMID: 30514675 PMCID: PMC6744114 DOI: 10.12122/j.issn.1673-4254.2018.11.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To investigate the effects of propofol combined with hypoxia on cognitive function of immature rats and the possible role of p38 pathway and tau protein in mediating such effects. METHODS Ninety 7-day-old (P7) SD rats were randomized for daily intraperitoneal injection of propofol (50 mg/kg) or lipid emulsion (5.0 mL/kg) for 7 consecutive days. After each injection, the rats were placed in a warm box (38 ℃) with an oxygen concentration of 18% (hypoxia), 21% (normal air), or 50% (oxygen) until full recovery of the righting reflex. Another 90 P7 rats were similarly grouped and received intraperitoneal injections of p-p38 blocker (15 mg/kg) 30 min before the same treaments. The phosphorylated tau protein, total tau protein and p-p38 content in the hippocampus were detected using Western blotting. The spatial learning and memory abilities of the rats were evaluated with Morris water maze test. RESULTS Compared with lipid emulsion, propofol injection resulted in significantly increased levels of p-p38, phosphorylated tau and total tau proteins in rats with subsequent hypoxic or normal air treatment (P < 0.05), but propofol with oxygen and injections of the blocker before propofol did not cause significant changes in the proteins. Without subsequent oxygenation, the rats receiving injections of propofol, with and without prior blocker injection, all showed significantly prolonged latency time and reduced platform-crossing times and third quadrant residence time compared with the corresponding lipid emulsion groups (P < 0.05). With oxygen treatment, the rats in propofoland blocker-treated groups showed no significant difference in the performance in Morris water maze test from the corresponding lipid emulsion group. The results of Morris water maze test differed significantly between blocker-propofol group and propofol groups irrespective of exposures to different oxygen levels (P < 0.05), but not between the lipid emulsion and blocker group pairs with exposures to different oxygen levels. CONCLUSIONS Propofol combined with hypoxia can affect the expression of tau protein through p38 pathway to impair the cognitive function of immature rats, in which oxygen plays a protective role.
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Affiliation(s)
- Jing Zhang
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Critical Disorders, Chongqing 400014, China
| | - Qing Yu
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Yang Liu
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Hui Liu
- Ministry of Education Key Laboratory of Child Development and Critical Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Mang Sun
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Qin Tian
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Shengfen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
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Hentia C, Rizzato A, Camporesi E, Yang Z, Muntean DM, Săndesc D, Bosco G. An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning. Brain Behav 2018; 8:e00959. [PMID: 29761012 PMCID: PMC5943756 DOI: 10.1002/brb3.959] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Ischemia/reperfusion (I/R) injury, such as myocardial infarction, stroke, and peripheral vascular disease, has been recognized as the most frequent causes of devastating disorders and death currently. Protective effect of various preconditioning stimuli, including hyperbaric oxygen (HBO), has been proposed in the management of I/R. METHODS In this study, we searched and reviewed up-to-date published papers to explore the pathophysiology of I/R injury and to understand the mechanisms underlying the protective effect of HBO as conditioning strategy. RESULTS Animal study and clinic observation support the notion that HBO therapy and conditioning provide beneficial effect against the deleterious effects of postischemic reperfusion. Several explanations have been proposed. The first likely mechanism may be that HBO counteracts hypoxia and reduces I/R injury by improving oxygen delivery to an area with diminished blood flow. Secondly, by reducing hypoxia-ischemia, HBO reduces all the pathological events as a consequence of hypoxia, including tissue edema, increased affective area permeability, postischemia derangement of tissue metabolism, and inflammation. Thirdly, HBO may directly affect cell apoptosis, signal transduction, and gene expression in those that are sensitive to oxygen or hypoxia. HBO provides a reservoir of oxygen at cellular level not only carried by blood, but also by diffusion from the interstitial tissue where it reaches high concentration that may last for several hours, improves endothelial function and rheology, and decreases local inflammation and edema. CONCLUSION Evidence suggests the benefits of HBO when used as a preconditioning stimulus in the setting of I/R injury. Translating the beneficial effects of HBO into current practice requires, as for the "conditioning strategies", a thorough consideration of risk factors, comorbidities, and comedications that could interfere with HBO-related protection.
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Affiliation(s)
- Ciprian Hentia
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy.,Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Alex Rizzato
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy
| | | | - Zhongjin Yang
- The Institute for Human Performance SUNY Upstate Medical University Syracuse NY USA
| | - Danina M Muntean
- Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania.,Center for Translational Research and Systems Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Dorel Săndesc
- Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Gerardo Bosco
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy
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22
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Francis A, Baynosa R. Ischaemia-reperfusion injury and hyperbaric oxygen pathways: a review of cellular mechanisms. Diving Hyperb Med 2017. [PMID: 28641323 DOI: 10.28920/dhm47.2.110-117] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ischaemia-induced tissue injury has wide-ranging clinical implications including myocardial infarction, stroke, compartment syndrome, ischaemic renal failure and replantation and revascularization. However, the restoration of blood flow produces a 'second hit' phenomenon, the effect of which is greater than the initial ischaemic event and characterizes ischaemia-reperfusion (IR) injury. Some examples of potential settings of IR injury include: following thrombolytic therapy for stroke, invasive cardiovascular procedures, solid organ transplantation, and major trauma resuscitation. Pathophysiological events of IR injury are the result of reactive oxygen species (ROS) production, microvascular vasoconstriction, and ultimately endothelial cell-neutrophil adhesion with subsequent neutrophil infiltration of the affected tissue. Initially thought to increase the amount of free radical oxygen in the system, hyperbaric oxygen (HBO) has demonstrated a protective effect on tissues by influencing the same mechanisms responsible for IR injury. Consequently, HBO has tremendous therapeutic value. We review the biochemical mechanisms of ischaemia-reperfusion injury and the effects of HBO following ischaemia-reperfusion.
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Affiliation(s)
- Ashish Francis
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, 1701 W Charleston Blvd, Suite 400, Las Vegas, NV 89102, USA,
| | - Richard Baynosa
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, USA
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Gao ZX, Rao J, Li YH. Hyperbaric oxygen preconditioning improves postoperative cognitive dysfunction by reducing oxidant stress and inflammation. Neural Regen Res 2017; 12:329-336. [PMID: 28400818 PMCID: PMC5361520 DOI: 10.4103/1673-5374.200816] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Postoperative cognitive dysfunction is a crucial public health issue that has been increasingly studied in efforts to reduce symptoms or prevent its occurrence. However, effective advances remain lacking. Hyperbaric oxygen preconditioning has proved to protect vital organs, such as the heart, liver, and brain. Recently, it has been introduced and widely studied in the prevention of postoperative cognitive dysfunction, with promising results. However, the neuroprotective mechanisms underlying this phenomenon remain controversial. This review summarizes and highlights the definition and application of hyperbaric oxygen preconditioning, the perniciousness and pathogenetic mechanism underlying postoperative cognitive dysfunction, and the effects that hyperbaric oxygen preconditioning has on postoperative cognitive dysfunction. Finally, we conclude that hyperbaric oxygen preconditioning is an effective and feasible method to prevent, alleviate, and improve postoperative cognitive dysfunction, and that its mechanism of action is very complex, involving the stimulation of endogenous antioxidant and anti-inflammation defense systems.
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Affiliation(s)
- Zhi-Xin Gao
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Jin Rao
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yuan-Hai Li
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
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Protection strategies during cardiopulmonary bypass: ventilation, anesthetics and oxygen. Curr Opin Anaesthesiol 2015; 28:73-80. [PMID: 25486490 DOI: 10.1097/aco.0000000000000143] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW To provide an update of research findings regarding the protection strategies utilized for patients undergoing cardiopulmonary bypass (CPB), including perioperative ventilatory strategies, different anesthetic regimens, and inspiratory oxygen fraction. The article will review and comment on some of the most important findings in this field to provide a global view of strategies that may improve patient outcomes by reducing inflammation. RECENT FINDINGS Postoperative complications are directly related to ischemia and inflammation. The application of lung-protective ventilation with lower tidal volumes and higher positive end-expiratory pressure reduces inflammation, thereby reducing postoperative pulmonary complications. Although inhalation anesthesia has clear cardioprotective effects compared with intravenous anesthesia, several factors can interfere to reduce cardioprotection. Hyperoxia up to 0.8 FiO(2) may confer benefits without increasing oxidative stress or postoperative pulmonary complications. During the early postoperative period, inhalation anesthesia prior to extubation and the application of preventive noninvasive ventilation may reduce cardiac and pulmonary complications, improving patients' outcomes. SUMMARY Lung-protective mechanical ventilation, inhalation anesthesia, and high FiO(2) have the potential to reduce postoperative complications in patients undergoing CPB; however, larger, well powered, randomized control trials are still needed.
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Lee TK, Lee CM, Hwang H, Jeong HS, Oh PS, Kwon J, Kim SH, Lim S, Sohn MH, Jeong HJ. Scintigraphic evaluation of therapeutic angiogenesis induced by VEGF-loaded chitosan nanoparticles in a rodent model of hindlimb ischemia. Macromol Res 2015. [DOI: 10.1007/s13233-015-3075-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karimi AA, Ajami M, Asadi Y, Aboutaleb N, Gorjipour F, Malekloo R, Pazoki-Toroudi H. Improvement of tissue survival of skin flaps by 5α-reductase inhibitors: possible involvement of nitric oxide and inducible nitric oxide synthase. IRANIAN BIOMEDICAL JOURNAL 2015; 19:111-6. [PMID: 25864816 PMCID: PMC4412922 DOI: 10.6091/ibj.1408.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Skin flap grafting is a popular approach for reconstruction of critical skin and underlying soft tissue injuries. In a previous study, we demonstrated the beneficial effects of two 5α-reductase inhibitors, azelaic acid and finasteride, on tissue survival in a rat model of skin flap grafting. In the current study, we investigated the involvement of nitric oxide and inducible nitric oxide synthase (iNOS) in graft survival mediated by these agents. Methods: A number of 42 male rats were randomly allocated into six groups: 1, normal saline topical application; 2, azelaic acid (100 mg/flap); 3, finasteride (1 mg/flap); 4, injection of L-NG-nitroarginine methyl ester (L-NAME) (i.p., 20 mg/kg); 5, L-NAME (20 mg/kg, i.p.) + azelaic acid (100 mg/flap, topical); 6, L-NAME (20 mg/kg, i.p.) + finasteride (1 mg/flap, topical). Tissue survival, level of nitric oxide, and iNOS expression in groups were measured. Results: Our data revealed that azelaic acid and finasteride significantly increased the expression of iNOS protein and nitric oxide (NO) levels in graft tissue (P < 0.05). These increases in iNOS expression and NO level were associated with higher survival of the graft tissue. Conclusion: It appears that alterations of the NO metabolism are implicated in the azelaic acid- and finasteride-mediated survival of the skin flaps.
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Affiliation(s)
- Ali Asghar Karimi
- Dept. of Physiology and Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Ajami
- Dept. of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasin Asadi
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Aboutaleb
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fazel Gorjipour
- Dept. of Physiology and Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Malekloo
- Physiology Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamidreza Pazoki-Toroudi
- Dept. of Physiology and Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Rech FV, Fagundes ALN, Simões RS, Florencio-Silva R, Sasso GRDS, Taha MO, Fagundes DJ. Action of hyperbaric oxygenation in the rat skin flap. Acta Cir Bras 2015; 30:235-41. [PMID: 25923255 DOI: 10.1590/s0102-865020150040000001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/18/2015] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the morphology, necrotic area and collagen content in skin flaps of rats subjected to hyperbaric oxygenation (HBO). METHODS Forty adult rats were divided into four groups: GEC - epilated; GE/HBO - epilated subjected to HBO; GER - epilated submitted to skin flap (2 cm in width /8 cm length in the dorsal area) and GER/HBO - epilated, subjected to skin flap and HBO. HBO (2.4 ATA) was performed for two hours during seven consecutive days. In the eighth day, the rats were anesthetized and the skin flaps were removed and separated into three portions, relative to pedicle fixation. The material fixed in 10% formalin was processed for paraffin embedding; sections were stained by H.E and subjected to picrosirius-red method. The slides examined under light microscopy for evaluation of the collagen content in polarized light microscope and ImageLab(r) software (Bio-Rad). RESULTS The data showed larger area of necrosis and lower levels of collagen in the three regions of the GER group, whereas in the GER/HBO group the collagen content was similar to the GEC and GE/HBO groups. CONCLUSION Hyperbaric oxygenation reduced the area of necrosis and preserved the morphology and collagen content in skin flaps of rats.
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Abstract
Hyperbaric oxygen therapy (HBOT) is defined as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1.0 atmosphere absolute, ATA). In China, for nearly 50 years, HBOT has been used as a primary or adjuvant therapy to treat a variety of diseases. This article mainly reviewed the indications and contraindications of HBOT, as well as the status of clinical and experimental HBOT research in China. At the same time, there is a brief introduction of hyperbaric oxygen preconditioning (HBO-PC) in China.
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Affiliation(s)
- Ling Yan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016 China
| | - Ting Liang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016 China
| | - Oumei Cheng
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016 China
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Kim SY, Rah DK, Chong Y, Lee SH, Park TH. Bilirubin provides perforator flap protection from ischaemia-reperfusion injury in a rat model: a preliminary result. Int Wound J 2015; 13:870-7. [PMID: 25619497 DOI: 10.1111/iwj.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/29/2014] [Accepted: 10/20/2014] [Indexed: 01/13/2023] Open
Abstract
The use of bilirubin, a well-known and powerful antioxidant, has gained popularity in recent years because of its role in the prevention of ischaemic heart disease in patients with Gilbert's syndrome. We investigate the effects of bilirubin on ischaemia-reperfusion (I/R) injury using a rat perforator flap model. Forty-eight rats were randomly divided into two groups: experimental (bilirubin) group (n = 24) and control group (n = 24). In each group, elevated bilateral deep inferior epigastric perforator (DIEP) flaps were created. The right (no ischaemia side) and left (ischaemia side) DIEP flaps were separated according to the presence of ischaemia induction. Ischaemia was induced in anaesthetised rats by perforator clamping for 15 or 30 minutes. After surgery, the flap survival was assessed daily on postoperative days 0 to 5, and overall histological changes of DIEP flaps above the perforator were analysed at postoperative day 5. The flap survival rate in the bilirubin group was significantly higher than that in the control group at the ischaemia side following perforator clamping for 15 or 30 minutes (93·42 ± 4·48% versus 89·63 ± 3·98%, P = 0·002; and 83·96 ± 4·23% versus 36·46 ± 6·38%, P < 0·001, respectively). The difference in flap survival between the two groups was the most prominent on the ischaemic side following 30 minutes of perforator clamping. From a morphologic perspective, pre-treatment with bilirubin was found to alleviate perforator flap necrosis caused by I/R injury in this experimental rat model.
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Affiliation(s)
- Sung Young Kim
- Department of Biochemistry, College of Medicine, Konkuk University, Seoul, South Korea
| | - Dong Kyun Rah
- Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Yosep Chong
- Department of Pathology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Song Hyun Lee
- Department of Biochemistry, College of Medicine, Konkuk University, Seoul, South Korea
| | - Tae Hwan Park
- Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, College of Medicine, Yonsei University, Seoul, South Korea.
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