Inflammatory response associated with choke vessel remodeling in the extended perforator flap model

Abstract

Ischemic necrosis of the surgical flap is a common complication. The behavior of choke vessels has an important role in skin flap survival. However, the mechanism of choke vessel remodeling has remained elusive. The purpose of the present study was to investigate the possible association between inflammatory responses and choke vessel remodeling in the extended perforator flap model in rats. After flap elevation, the animals were randomly divided into three groups (n=6 in each) for tissue analysis at three, five or seven days after flap surgery. Six additional rats served as a control group (no flap elevation). Tissue samples were collected from the choke zone for histological, western blot and PCR analyses. Monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α) as inflammatory cytokines were examined in the present study. Histopathological analysis showed that dilation of choke vessels and increased vessel wall thickness was obvious after flap elevation. It also showed edema, inflammation cell aggregation after the operation. Compared with the control group, the protein and mRNA expression levels of MCP-1 and TNF-α were significantly increased at days 3, 5 and 7 after flap elevation, while reaching a maximum at day 5. These findings indicated that inflammatory responses may have an important role in choke vessel remodeling. MCP-1 and TNF-α may be considered as potential targets for modulating the behavior of choke vessels.

Bioactive nanoparticle-based formulations increase survival area of perforator flaps in a rat model

“…Qing et al . reported increased levels of MCP-1 in the flap areas where growth of choke vessels was detected, thereby leading to increased vascularisation of the distal part of the flap [ 5 ]. In their study, peak values of MCP-1 were recorded on POD 5 with decreasing MCP-1 concentrations on POD 7, indicating a decline in MCP-1 expression once new vessels have formed, which might again be in line with our findings at POD 7.…”

“…There is evidence suggesting that the sprouting of microvessels from a pre-existing network is triggered by an inflammatory environment [ 4 ]. Even though some of the principles involved in flap survival have been elucidated, distal flap necrosis remains one of the most feared complications in the clinical setting [ 5 ].…”

<p>Tetramethylpyrazine improved the survival of multiterritory perforator flaps by inducing angiogenesis and suppressing apoptosis via the Akt/Nrf2 pathway</p>

“…In this study, the multiterritory perforator flap model was performed according to our previous study 21. Briefly, the rats were anesthetized with pentobarbital sodium anesthesia (30 mg/kg, intraperitoneal).…”

Detrimental Effect of Sitagliptin Induced Autophagy on Multiterritory Perforator Flap Survival

“…Previous studies have revealed that necrosis usually occurs away from the boundary between potential and dynamic territory ( Taylor et al., 1992 ; Fichter et al., 2016 ). Occurrence of necrosis increases the number of surgeries and is directly lead to a patient's dissatisfaction with the treatment ( Gill et al., 2004 ; Qing et al., 2017 ). Choke vessel as a kind of resistant vessel that connected two contiguous angiosomes ( Taylor and Palmer, 1987 ).…”