The Influence of Diabetes Mellitus on Survival of Abdominal Perforator Flaps: An Experimental Study in Rats with Slowly Induced Diabetes Mellitus

Baldea, Bogdan Ionut; Toader, Septimiu; Orbai, P; Bârsan, Simona; Olariu, Radu; Grigorescu, Dan Ovidiu; Penciu, Marius; Nagy, András; Georgescu, Alexandru Valentin

doi:10.1055/s-0034-1394101

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…Several studies have revealed a decreased survival of random skin flap and perforator flap in rats with tissue ischemia due to diabetes (13). Chronic hyperglycemia in diabetes constributes to endothelial cell dysfunction, reduced angiogenesis, and dysregulation of endothelial nitrogen oxide synthase (eNOS), subsequently disrupting the healing process.…”

Section: Discussionmentioning

confidence: 99%

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Kamayana,

Hamid,

Mahadewa

et al. 2024

Arch Plast Surg

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Background The risk of flap necrosis in tissue reconstruction surgery is elevated in patients with vascular disorders, such as diabetes mellitus. Chronic hyperglycaemia causes endothelial cell dysfunction and increases inflammatory process, causing vascular insufficiency. Platelet-rich plasma (PRP) contains high levels of platelets, growth factors and fibrinogens. Its regenerative properties spark interest in supporting flap survival in relation to diabetic complications. Methods Thirty Wistar rats were divided into three groups. The first group included diabetic rats without PRP injection, which underwent flap procedure. The second group included diabetes-induced rats receiving PRP subcutaneous injection one day prior to flap procedure. The third group included non-diabetic rats receiving PRP injection one day prior to flap procedure. Flap tissue samples were taken on the seventh day to measure VEGF levels using enzyme-linked immunosorbent assay (ELISA) method; angiogenesis and collagen density were measured from histopathology examination, and flap viability was analysed using digital measurements. Results Analysis showed that flap viability, angiogenesis and VEGF levels were significantly higher in the PRP-injected diabetic rats compared to diabetic rats that did not receive PRP. The levels of VEGF, angiogenesis and viability of flaps in diabetic rats given PRP did not differ significantly compared to non-diabetic rats that received PRP. Conclusion Flap preconditioning through local injection of activated PRP enhances flap viability, VEGF levels and angiogenesis, in random skin flaps in diabetic rats, to the level where it does not differ significantly to non-diabetic rats that were given PRP. Keywords. Platelet-rich plasma, diabetes mellitus, VEGF, angiogenesis, random skin flap

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Section: Discussionmentioning

confidence: 99%

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Kamayana,

Hamid,

Mahadewa

et al. 2024

Arch Plast Surg

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“…Diabetes was induced by an intraperitoneal application of 50 mg/ kg of streptozotocin (STZ; Solarbio, Beijing, China), as previously described. 29,30 The STZ was dissolved in a vehicle (citrate buffer, 0.1 M, pH 4.5; Sigma, St. Louis, MO). The control group was injected with an equivalent volume of citrate buffer.…”

Section: Methodsmentioning

confidence: 99%

Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model

Zhang

Wang

et al. 2022

Journal of Craniofacial Surgery

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Glucose has been used in the monitoring of transplanted flaps. However, few studies have focused on the effect of diabetes on the decrease in flap glucose levels. The purpose of this study was to evaluate the application of continuous interstitial glucose monitoring to detect flap venous occlusion in a diabetic rat model. The flap interstitial glucose level was measured by transcutaneous sensors in the bilateral vertical rectus abdominis myocutaneous flaps of each rat. interstitial glucose values in the bilateral flaps were recorded every 5 minutes after the venous occlusion of 1 flap. Forty-one rats were divided into the control group (n = 13), diabetic group (n = 15, established by the intraperitoneal injection of streptozotocin), and insulintreated diabetic group (n = 13, systemic glucose well controlled by insulin before surgery). Results indicated that flap interstitial glucose decreased to the lowest level in all flaps with venous occlusion. The time from venous occlusionto the lowest interstitial glucose level was significantlylongerinthe diabetic group than the control group (120.8 ± 5.7 minutes versus 56.5 ± 6.7 min-minutes, P < 0.001), but was similar in the insulintreated diabetic and control groups (56.5 ± 6.7 minutes versus 56.0 ± 6.6 minutes, P = 0.876). The change in interstitial glucose in both the diabetic and insulin-treated diabetic groups began with a plateau period or a slow decline before decreasing for 49.0 ± 6.4 minutes and 24.4 ± 4.3 min-minutes, respectively. in a diabetic rat model, impaired glucose metabolism prolongs the required monitoring time and dulls the reaction of flap interstitial glucose to venous congestion. Insulin restores the prolonged monitoring time, but not the reaction of flap interstitial glucose. Therefore, care is needed during application of the technique in diabetic patients.

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“…In contrast, Tegenge et al's broader analysis across various ExCR delivery modes showed VO2peak improvements following center-based (3.10 mL/kg/min), home-based (2.69 mL/kg/min), and technology-enabled ExCR (1.76 mL/kg/min), alongside reductions in HF-related hospitalization and mortality risks only after center-based ExCR (OR = 0.41 for hospitalization and OR = 0.42 for mortality) [36]. Similarly, Murray et al [27] identified a significant improvement among patients with DM as well, a very common comorbidity correlated with HF and other pathologies [37,38].…”

Section: Summary Of Evidencementioning

confidence: 97%

Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review

Sukosd,

Pescariu,

Faur

et al. 2024

Diseases

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This systematic review evaluates the effectiveness of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in assessing quality of life improvements among patients with heart failure (HF) undergoing various forms of exercise training rehabilitation, including telemedicine and in-person modalities, across all stages of HF, irrespective of ejection fraction (EF) and clinical status. The aim was to collate evidence from studies employing the KCCQ as a measure of quality of life (QoL). A comprehensive search strategy was implemented across PubMed, Scopus, and Embase databases, adhering to the PRISMA guidelines, including literature up until October 2023. Inclusion criteria encompassed studies on patients diagnosed with HF undergoing exercise training rehabilitation assessed by KCCQ. Nine articles met the inclusion criteria, involving a total of 3905 patients from various global locations and conducted between 2012 and 2022. Results indicated significant heterogeneity in exercise interventions and patient characteristics. Notably, high-intensity interval training (HIIT) showed a marked improvement in KCCQ scores (from 68.0 to 80.0) compared to moderate continuous training (MCT) and control groups, underscoring its potential for enhancing QoL. Additionally, a significant improvement in the 6-min walking test (6MWT) outcomes was observed, with an average increase of 106 m (95% CI: 60, 152) in one study, reflecting physical capacity enhancements. However, the difference in KCCQ scores between intervention and control groups was not statistically significant in several studies. In conclusion, the KCCQ’s effectiveness is highlighted by its ability to detect clinically meaningful improvements in QoL across diverse exercise modalities, including HIIT and MCT, tailored to the specific needs of HF populations. The consistent correlation between KCCQ score improvements and enhanced physical outcomes, such as the 6MWT, supports its reliability in capturing the nuanced benefits of exercise interventions on patient well-being.

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The Influence of Diabetes Mellitus on Survival of Abdominal Perforator Flaps: An Experimental Study in Rats with Slowly Induced Diabetes Mellitus

Abstract: Perforator flaps can be successfully used for coverage of cutaneous defects in a rat diabetic model. These flaps show higher complication rates in diabetic versus nondiabetic animals; however, this complication rate has little influence on flap survival.

Cited by 6 publications

References 42 publications

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model

Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review

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