Role of the NO/cGMP Pathway in Postoperative Vasodilation in Perforator Flaps

Gao, Zhengzheng; Lin, Dong; Wang, Y.; Li, J. J.; Chen, S.; Gao, Weiyang

doi:10.1055/s-0034-1384663

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…Dorsal fur was removed using an electric shaver and depilatory cream. The flap position was based on bony landmarks on the right side of the rat dorsum as reported previously 11,12 and the surgery was performed under sterile conditions. The flap (2.5 Â 11.0 cm) was elevated beneath the panniculus carnosus with three vascular territories, including the lateral thoracodorsal (TD) vessel, posterior intercostal (IC) vessel, and deep circumflex iliac (DCI) vessel.…”

Section: Flap Modelmentioning

confidence: 99%

Vasculature Characterization of a Multiterritory Perforator Flap: An Experimental Study

Wang

Zhou

Yang

et al. 2017

J reconstr Microsurg

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Tip necrosis in the perforator flap is a significant problem in clinical practice. This study aimed to characterize the vasculature of a multiterritory perforator flap using a rat model and to investigate the impact of the vasculature on flap survival. In total, 105 Sprague Dawley rats were divided into seven groups, including the control, 3 hours postoperative (PO), 12 hours PO, 1 day PO, 3 days PO, 5 days PO, and 7 days PO. A perforator flap with three territories based on the deep iliac circumflex artery was performed. Flaps with only skin incisions and vessel exposure were performed in the control group. The first choke zone (FCZ) was located between the anatomical and dynamic territories, and the second choke zone (SCZ) was located between the dynamic and potential territories. Sodium fluorescein and lead oxide-gelatin angiography and histological examination were performed in each group. Sodium fluorescein angiography revealed delayed staining in the perforator flap PO, particularly in the FCZ and SCZ. The delay phenomenon disappeared after 12 hours PO in the FCZ and after 1 day PO in the SCZ. Nonfluorescein-stained areas were found distal to the potential territory. In the FCZ PO, the choke vessels were dilated, while the number of microvessels was increased in the SCZ without choke vessel dilation. The remodeling of choke vessels and increase in microvessel number represent arteriogenesis and angiogenesis, respectively. This neovascularization was responsible for flap survival in the entire dynamic territory and part of the potential territory.

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Section: Flap Modelmentioning

confidence: 99%

Vasculature Characterization of a Multiterritory Perforator Flap: An Experimental Study

Wang

Zhou

Yang

et al. 2017

J reconstr Microsurg

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“…However, the potential territory survival is often limited and unstable. Inadequate dilation of blood vessels, 2 an absence of angiogenesis, 3 and ischemia-reperfusion injury 4 are the important causes of skin flap necrosis.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Inducible Nitric Oxide Synthase on Multiterritory Perforator Flap Survival in Rats

Xianyao

Wang

Gao

et al. 2016

J reconstr Microsurg

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Inducible nitric oxide synthase (iNOS) plays an important role in vasodilation, angiogenesis, and ischemia-reperfusion injury. We investigated the effects of iNOS on the survival and choke vessels of multiterritory perforator flaps in rats. In this study, 84 rats were divided into two groups of 42 rats each and subjected to multiterritory perforator flap operations. Rats in group A received daily intraperitoneal doses of 100 mg per kg of aminoguanidine (AG) and rats in group B received daily intraperitoneal injections of the same volume of saline solution. On postoperative day 7, the surviving flap area was calculated as a percentage of the total flap dimensions using DP2-BSW software. The diameter and density of microvessels in the second choke zone of the flap were calculated from histology studies. The nitric oxide (NO) content was measured using NO concentration assay kits, and the levels of vascular endothelial growth factor (VEGF) and iNOS were assessed using western blotting. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were measured using test kits. Laser Doppler imaging was used to evaluate flap perfusion in the second choke zone for 7 days after surgery. The flap survival area, diameter and density of microvessels, iNOS and VEGF levels, NO content, blood perfusion, and MDA content were significantly higher in the control group compared with the AG group, whereas SOD activity was significantly lower in the control group. iNOS has a beneficial effect on the survival of multiterritory perforator flaps.

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“…Accordingly, vasodilation of the remaining core vessels of the flap and/or the vasodilation of collaterals—so‐called arteriogenesis—may account for it. The role of NO and flow‐mediated dilation in arteriogenesis was demonstrated in an ischaemic skin flap, which may therefore be a candidate mechanism for mucogingival flap survival.…”

Section: Discussionmentioning

confidence: 99%

Evidence of spreading vasodilation in the human gingiva evoked by nitric oxide

Gánti

Molnár

Fazekas

et al. 2019

J of Periodontal Research

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Background and Objective Spreading vasodilation is an important means of increasing local blood flow effectively during increased metabolic demands or in case of vascular injury. Our aim was to develop a technique proving the presence of spreading vasodilation in the human keratinized gingiva. Methods Local vasodilation was evoked by the application of nitric oxide (NO) donor nitroglycerin into a well, fixed 2 mm above the marginal gingiva, in 20 subjects with healthy periodontal tissue. Either 1 or 8 mg/mL nitroglycerin solutions were dropped into the test well at the upper right second incisor, and saline was applied into the control well at the upper left first incisor. The gingival blood flow (GBF) was recorded for 15 minutes by a laser speckle contrast imager below the well and in the surrounding area in the mesial, distal, apical and coronal directions. Gingival thickness was measured by an ultrasonic biometer. Results Peak GBF increase was similar after 1 mg/mL and after 8 mg/mL nitroglycerin application in the well (51% ± 12% vs 42% ± 8%) and in the apical region (33 ± 9% vs 55% ± 13%). While the lower dose of nitroglycerin increased GBF only in the apical region around the well, the higher dose induced significant elevations in all surrounding regions, with apical prominence. Hyperaemia lasted 10‐14 minutes in the low‐dose group whereas it extended beyond the observation period in the high‐dose group. Neither the baseline nor the NO‐induced peak GBF were correlated with gingival thickness. Conclusion The role of the direct effect of NO in the regulation of perfusion was demonstrated in the human gingiva as well as the propagation of local vasodilation to distant, especially apical areas, probably by the mechanism of flow‐mediated dilation. This mechanism may have a clinical importance for flap survival or wound healing.

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Role of the NO/cGMP Pathway in Postoperative Vasodilation in Perforator Flaps

Abstract: Targeting the NO/cGMP pathway can dilate vessels along the axis of the flap, including the choke vessels, thus augmenting flap viability. Therefore, targeting of this pathway may have therapeutic applications.

Cited by 16 publications

References 14 publications

Vasculature Characterization of a Multiterritory Perforator Flap: An Experimental Study

Vasculature Characterization of a Multiterritory Perforator Flap: An Experimental Study

The Effect of Inducible Nitric Oxide Synthase on Multiterritory Perforator Flap Survival in Rats

Evidence of spreading vasodilation in the human gingiva evoked by nitric oxide

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