Summary
Background
Endothelial progenitor cells (EPCs) are one type of bone marrow hematopoietic stromal
cells which play a vital role in neovascularization and tissue repair. In this study,
we investigated whether EPCs promote flap survival in a rabbit venous model.
Materials and methods
EPCs were customized from CHI Scientific, Inc, China. Thirty-six rabbits were randomly
assigned to either the sham group (n = 12), the control group (n = 12) or the EPC transplantation group (n = 12). A 10 × 6 cm venous flap was created on the rabbit abdomen. Both the EPC transplantation
and control groups had the same volume of EPCs–PBS (phosphate buffered saline) and
PBS on postoperative day 1. Flap survival, blood flow, histopathology, expression
of endothelial nitric oxide synthase (eNOs) and Vascular Endothelial Growth Factor
(VEGF) were detected on postoperative day 10.
Results
Cellular immunofluorescence assay positively confirmed that the EPCs were undergoing
differentiation. The survival rate of the flap in the EPC transplantation group was
58.4 ± 7.1%, which was significantly higher than that of the control group (4.8 ± 3.4%)
(p<0.01). Histological examination revealed that the EPC transplantation group had higher
microvessel density, fewer inflammatory cells, and a higher expression of eNOs and
VEGF. Significantly increased blood flow perfusion was seen in the EPC transplantation
group using laser Doppler imaging. The Western Blot technique revealed that the expression
of eNOs and VEGF in the EPC transplantation group were both significantly higher than
those in the control group.
Conclusion
This study demonstrated that EPC transplantation improved venous flap survival in
rabbits. The present findings may provide insight into the promotion of venous flap
survival in clinical practice in the future.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical applications of venous flaps in the reconstruction of hands and fingers.Arch Orthop Trauma Surg. 2011; 131: 65-74
- A comparative study of finger pulp reconstruction using arterialised venous sensate flap and insensate flap from forearm.J Plast Reconstr Aesthet Surg. 2012; 65: 1220-1226
- Reconstruction of large dorsal digital defects with arterialized venous flaps: our experience and comprehensive review of literature.Ann Plast Surg. 2013; 70: 666-671
- Use of the venous flap for salvage of difficult ring avulsion injuries.Microsurgery. 2008; 28: 397-402
- Venous flaps for coverage of traumatic soft tissue defects of the hand: a systematic review.J Hand Surg (Eur Vol). 2017; 42: 817-822
- Update on ischemia-reperfusion injury for the plastic surgeon: 2011.Plast Reconstr Surg. 2011; 128: 685e-692e
- Bone-marrow haematopoietic-stem-cell niches.Nat Rev Immunol. 2006; 6: 93-106
- Progenitor cell trafficking is regulated by hypoxic gradients through HIF-1 induction of SDF-1.Nat Med. 2004; 10: 858-864
- Age decreases endothelial progenitor cell recruitment through decreases in hypoxia-inducible factor 1alpha stabilization during ischemia.Circulation. 2007; 116: 2818-2829
- Effects of magnetically labeled exogenous endothelial progenitor cells on cerebral blood perfusion and microvasculature alterations after traumatic brain injury in rat model.Acta Radiol. 2013; 54: 313
- Endothelial progenitor cells for the vascularization of engineered tissues.Tissue Eng Part B Rev. 2018; 24: 1-24
- Number and migratory activity of circulating endothelial progenitor cells inversely correlate with risk factors for coronary artery disease.Circ Res. 2001; 89: E1
- Therapeutic potential of ex vivo expanded endothelial progenitor cells for myocardial ischemia.Circulation. 2001; 103: 634-637
- Arterialized venous flaps: a review of the literature.Microsurgery. 2010; 30: 472-478
- Arterialized venous flap coverage for skin defects of the hand or foot.J Reconstr Microsurg. 1988; 4: 259-266
- Venous flaps for covering skin defects of the hand.J Reconstr Microsurg. 1994; 10: 313-319
- Finger soft tissue reconstruction using arterialized venous free flaps having 2 parallel veins.J Hand Surg Am. 2008; 33: 1802-1806
- Closure of big toe defects after wrap-around flap transfer using the arterialized venous flap.J Reconstr Microsurg. 1991; 7: 1-8
- Non-invasive flap preconditioning by foam-mediated external suction improves the survival of fascio-cutaneous axial-pattern flaps in a type-2 diabetic murine model.Plastic Reconstr Surg. 2018; 142: 872e-883e
- Noninvasive induction of angiogenesis in tissues by external suction: sequential optimization for use in reconstructive surgery.Angiogenesis. 2017; 21: 61-78
- An old dream revitalised: preconditioning strategies to protect surgical flaps from critical ischaemia and ischaemia-reperfusion injury.J Plastic Reconstr Aesthet Surg. 2008; 61: 503-511
- The value of postconditioning in plastic and reconstructive surgery: a systematic review.J Reconstr Microsurg. 2016; 32: 285-293
- [Treatment of ischemia-reperfusion injury of flap].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011; 25: 373-376
- Comparison of two types of arterialized venous forearm flaps for oral reconstruction and proposal of a reliable procedure.J Cranio-Maxillofac Surg. 1998; 26: 249-254
- The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits.Plastic Reconstr Surg. 1998; 102: 1134
- Effects of delay procedures on vasculature and survival of arterialized venous flaps: an experimental study in rabbits.Plastic Reconstr Surg. 1995; 96: 1650-1659
- Effects of blood flow and venous network on the survival of the arterialized venous flap.Plastic Reconstr Surg. 1998; 101: 1280-1289
- Experimental rat skin flap model that distinguishes between venous congestion and arterial ischemia.Plastic Reconstr Surg. 2017; 139: 79e-84e
- Large prefabricated skin flaps based on the venous system in rabbits: a preliminary study.Plast Reconstr Surg. 2013; 132: 372e-380e
- The effect of hemodynamic remodeling on the survival of arterialized venous flaps.PLoS One. 2013; 8: e79608
- Fetal bovine serum-free culture of endothelial progenitor cells – progress and challenges.J Tissue Eng Regen Med. 2018; 12: 1567-1578
- Epidermal stem cells in skin wound healing.Adv Wound Care (New Rochelle). 2017; 6: 297-307
- The role of mesenchymal stem cells in the regenerative wound healing phenotype.Adv Wound Care (New Rochelle). 2012; 1: 159-165
- Mesenchymal stem cell therapy for cutaneous wounds.Adv Wound Care (New Rochelle). 2012; 1: 166-171
- Exosomes derived from human endothelial progenitor cells accelerate cutaneous wound healing by promoting angiogenesis through Erk1/2 signaling.Int J Biol Sci. 2016; 12: 1472-1487
- Use of p53-silenced endothelial progenitor cells to treat ischemia in diabetic peripheral vascular disease.J Am Heart Assoc Cardiovasc Cerebrovasc Dis. 2017; 6e005146
- Isolation of putative progenitor endothelial cells for angiogenesis.Science. 1997; 275: 964
- Critical reevaluation of endothelial progenitor cell phenotypes for therapeutic and diagnostic use.Circ Res. 2012; 110: 624
- The biology of VEGF and its receptors.Nat Med. 2003; 9: 669-676
- Prevention of distal flap necrosis in a rat random skin flap model by gene electrotransfer delivering VEGF165plasmid.J Gene Med. 2014; 16: 55-65
- Effects of vascular endothelial growth factor on survival of surgical flaps: a review of experimental studies.J Reconstr Microsurg. 2014; 30: 1-13
- Vascular endothelial growth factor (VEGF) expression and the effect of exogenous VEGF on survival of a random flap in the rat.Br J Plastic Surg. 2003; 56: 653-659
- Biliverdin reductase-A attenuated GMH-induced inflammatory response in the spleen by inhibiting toll-like receptor-4 through eNOS/NO pathway.J Neuroinflammation. 2018; 15: 118
- New progress in roles of nitric oxide during hepatic ischemia reperfusion injury.World J Gastroenterol. 2017; 23: 2505-2510
- Nitric oxide synthases: regulation and function.Eur Heart J. 2012; 33 (37a-37d): 829-837
- Hydrogen sulfide improves postischemic neoangiogenesis in the hind limb of cystathionine-beta-synthase mutant mice via PPAR-gamma/VEGF axis.Physiol Rep. 2018; 6: e13858
- A conformational change in C-reactive protein enhances leukocyte recruitment and reactive oxygen species generation in ischemia/reperfusion injury.Front Immunol. 2018; 9: 675
Article info
Publication history
Published online: January 11, 2019
Accepted:
December 21,
2018
Received in revised form:
December 14,
2018
Received:
July 20,
2018
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
