Vascular and Epidermal Effects of Fibroblast Growth Factor on Irradiated and Nonirradiated Skin Flaps

Abstract

Head and neck cancer surgeons are often faced with the challenge of managing previously irradiated soft tissue that has poor vascularity and slower epithelialization. This study investigates the effect of supplemental basic fibroblast growth factor (bFGF) on flap vascularity, tissue oxygenation, and epidermal regeneration in nonirradiated (n = 40) and irradiated porcine skin flaps (n = 40). Supplemental bFGF increased vascularity in nonirradiated flaps by 80% (p = .005), with a trend to a higher tissue oxygen level by day 14. The irradiated bFGF-treated flaps did not show increased vascularity or higher tissue oxygen levels 2 weeks after surgery. However, in both irradiated and nonirradiated groups, epidermal regeneration increased by greater than 70% with supplemental bFGF (p < .002). The results of this study suggest that supplemental bFGF can increase tissue vascularity in nonirradiated tissues and epidermal regeneration in both nonirradiated and irradiated conditions.

Proangiogenic Soluble Factors from Amniotic Fluid Stem Cells Mediate the Recruitment of Endothelial Progenitors in a Model of Ischemic Fasciocutaneous Flap

“…Therapeutic angiogenesis is defined as the administration of proangiogenic factors to convert an ischemic tissue into a viable and functional tissue through the maintenance of existing vasculature or by stimulating the formation of new vessels [6,7]. Local and systemic application of angiogenic proteins, such as PDGF [8], basic FGF [9], and VEGF [10] have been demonstrated to improve the survival of compromised flaps, while fibrin sealants have been investigated for their hemostatic and adhesive properties and for the ability to locally deliver and sustainably release growth factors [11,12], thus providing an important role as a biomatrix in pursuing the angiogenic effect.…”

Improving Surgical Wound Healing with Basic Fibroblast Growth Factor after Radiation

“…This random skin flap model was used to give additional ischemia resulting in at least 35% necrosis of the distal flap segment. These porcine skin flap models have been established in previous studies 17,32,35 . In groups V and VI, two dorsally based random skin flaps were created on each side of the animal (4 flaps per pig).…”

“…These porcine skin flap models have been established in previous studies. 17,32,35 In groups V and VI, two dorsally based random skin flaps were created on each side of the animal (4 flaps per pig). Intravenous bFGF was administered systemically to six animals and intravenous PBS was given to five animals as the control.…”

Growth factors and flap survival

“…28,29 However, bFGF was found to be unsuccessful in increasing tissue vascularity in the irradiated flap. 30 Vascular endothelial growth factor (VEGF) is an endogenous stimulator of both angiogenesis and increased vascular permeability. 31,32 Many studies were conducted on the use of VEGF to induce therapeutic angiogenesis in improving flap survival.…”

“…Additional research on growth factors in flap survival obtained similar results with either systemic or local intratissue injection. 12,26,29,30,34,35,42,44 Applications of growth factors by routes of topical administration and immersed in gelfoam were also reported. 14À16,24,41 Intra-arterial administrations of growth factors were also demonstrated to improve the pedicled skin and muscle flap survival.…”