Improvement of Skin Paddle Survival by Application of Vascular Endothelial Growth Factor in a Rat TRAM Flap Model

Abstract

The effect of vascular endothelial growth factor (VEGF) on skin flap survival and its ability to induce a pharmacological delay by promoting angiogenesis in a flap was studied in a rat transverse rectus abdominis musculocutaneous flap, using a 3 x 8-cm skin paddle with the inferior epigastric vessels as its main vascular supply. Forty-three Sprague-Dawley rats were divided into four groups. In group 1, VEGF was injected into the femoral vein after the flap was elevated. In group 2, VEGF was injected intra-arterially into the flap through the superior epigastric artery after the flap was elevated. In group 3, VEGF was injected into the subcutaneous fascial layer in the area where the flap would be dissected, and the flap was then raised 7 days after injection. In group 4, the flap was dissected and replaced, using saline injection as the control. On postoperative day 5, the survival area of each skin paddle was measured and the flap was harvested for histological analysis. The results showed that the mean survival area +/- standard deviation for the skin paddle was 6.82 +/- 4.89 cm2 (28.4 +/- 20.4% of the whole skin paddle) in the control group, and 4.2 +/- 3.0 cm2 (17.5 +/- 12.5%) and 6.02 +/- 5.97 cm2 (25.1 +/- 24.9%) in the groups with VEGF systemic and intra-arterial administration respectively. The skin survival area in the group with preoperative subcutaneous administration of VEGF was 17.85 +/- 2.88 cm2 (74.4 +/- 12%), which was significantly higher than the other three groups (p < 0.01). Histological semiquantitative analysis showed increased neovascularization in the flap treated with VEGF preoperatively. The data demonstrate that preoperative treatment with VEGF can induce angiogenesis and enhance skin paddle survival in a musculocutaneous flap.

Use of Systemic Rosmarinus Officinalis to Enhance the Survival of Random-Pattern Skin Flaps

“…In that study, the skin flap was 11×3 cm in size, and the average ratio of the viable surface area to the total flap area in the control group was 59%. The average ratio of viable surface area to total flap area was found to be highest in a study investigating the effects of the subdermal use of vascular endothelial growth factor (VEGF) on flap viability (27). The effect of VEGF on skin flap survival was studied in a rat transverse rectus abdominis musculocutaneous flap using a 3×8 cm skin paddle with the inferior epigastric vessels.…”

Improvement of the skin flap survival with the bone marrow‐derived mononuclear cells transplantation in a rat model

“…Use of growth factors for the pharmacological delay for improvement of skin flap survival has been reported. 18 However, the application of the pharmacologi- cal delay with growth factors could be limited by their short half-life. ADSCs were first reported for improving neovascularization in the ischemic hind limb and ischemic myocardium in the animal model in 2001.…”

Efficacy and mechanism of adenovirus-mediated VEGF-165 gene therapy for augmentation of skin flap viability

“…It was speculated that angiogenesis plays an important role in VEGF-165 protein therapy in augmentation of skin flap viability (36,37). However, other investigators reported that local subcutaneous or subdermal injection of VEGF-165 protein into rat skin flaps or musculocutaneous flaps at the time of surgery was also effective in augmenting skin viability (16,19,26,33,47,48). In addition, we demonstrated that intra-arterial infusion of VEGF-165 induced potent relaxation in isolated perfused pig skin flaps (2) and that acute local subcutaneous injection of VEGF-165 increased skin blood flow and viability in rat dorsal skin flaps (16).…”