Injection of SVF combined with HBO2 improves viability of unfavorably designed flaps

Abstract

Purpose: Soft-tissue reconstruction is complicated by ischemia and reperfusion injury. Animal trials have documented the independent healing benefits of hyperbaric oxygen preconditioning (HBOP) and stem cell delivery in cutaneous flaps. We explored the role of HBOP and stem cell delivery in flap preconditioning and survival. Methods: We designed a randomized controlled trial to assess the effects of hyperbaric oxygen preconditioning and stromal vascular fraction (SVF) delivery on flap survival. Of the first 24 guinea pigs, six received neither HBOP nor injections, and six underwent HBOP without injections. Of the remaining 12 animals, six received SVF or saline injections in the absence of HBOP. The final six animals received autologous SVF injections or saline injections followed by four HBOP treatments. To enhance clinical relevance, a group of 6 animals underwent HBOP prior to SVF or saline injections. Thereafter, an unfavorably designed cutaneous flap was elevated and assessed via study-blinded observer, as well as by quantification of TUNEL-positive cells. Results: Distal necrosis of the tissue flap was more ex- tensive in the no-intervention group (45% of flap). Flaps treated with HBOP only and those treated with SVF injections demonstrated only 38.2% and 27.1% distal necrosis. The most significant difference occurred in the combination HBOP and SVF group, where distal necrosis was only 21.1% of the flap (p ≤ 0.05). SVF delivery immediately prior to flap elevation further minimized distal necrosis of the flap to 15.6%. These findings were mirrored by the TUNEL assay. Conclusions: Combining HBOP and SVF improves flap viability.

Anti-apoptotic effect of adipose tissue-derived stromal vascular fraction in denervated rat muscle

“…The anti-apoptotic nature of SVF has however not been as extensively studied as its potential to differentiate into other cell types, although it does seem promising. For example, recently, Lee et al [ 17 ] described how SVF injections significantly decreased apoptosis and TUNEL labeling in a rat model of acute kidney injury, and Tenenhaus et al [ 18 ] showed how necrosis after soft tissue reconstruction can be minimized using SVF injections.…”

Postconditioning With Red-Blue Light Therapy Improves Survival of Random Skin Flaps in a Rat Model

“…In recent years, a large number of drugs and physical methods are used in the study of random flap necrosis. Because of the complexity of the flap necrosis mechanism, many scholars have adopted combined therapy for prevention and treatment and achieved good results 31,32 . Photobiomodulation, as a noninvasive method, has been widely used clinically and has been shown to reduce necrosis in the ischemic flap, which is an ideal adjuvant treatment for other treatments 26 .…”

“…Because of the complexity of the flap necrosis mechanism, many scholars have adopted combined therapy for prevention and treatment and achieved good results. 31,32 Photobiomodulation, as a noninvasive method, has been widely used clinically and has been shown to reduce necrosis in the ischemic flap, which is an ideal adjuvant treatment for other treatments. 26 In the present study, we found that red-blue light improved flap survival.…”

An overview of hyperbaric oxygen preconditioning against ischemic stroke

“…In addition, HBO-PC improved myeloid, B cell, and T-cell engraftment in a murine transplant model (Aljitawi et al 2014 ). The combination of HBO-PC and stem cell therapy has been successfully used in cutaneous flaps (Tenenhaus et al 2018 ) and traumatic brain injury(Zhou et al 2016 ).…”