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Khalaf R, Duarte Bateman D, Reyes J, Najafali D, Rampazzo A, Bassiri Gharb B. Systematic review of pathologic markers in skin ischemia with and without reperfusion injury in microsurgical reconstruction: Biomarker alterations precede histological structure changes. Microsurgery 2024; 44:e31141. [PMID: 38361264 DOI: 10.1002/micr.31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Ischemia and ischemia-reperfusion injury contribute to partial or complete flap necrosis. Traditionally, skin histology has been used to evaluate morphological and structural changes, however histology does not detect early changes. We hypothesize that morphological and structural skin changes in response to ischemia and IRI occur late, and modification of gene and protein expression are the earliest changes in ischemia and IRI. METHODS A systematic review was performed in accordance with PRISMA guidelines. Studies reporting skin histology or gene/protein expression changes following ischemia with or without reperfusion injury published between 2002 and 2022 were included. The primary outcomes were descriptive and semi-quantitative histological structural changes, leukocyte infiltration, edema, vessel density; secondary outcomes were quantitative gene and protein expression intensity (PCR and western blot). Model type, experimental intervention, ischemia method and duration, reperfusion duration, biopsy location and time point were collected. RESULTS One hundred and one articles were included. Hematoxylin and eosin (H&E) showed inflammatory infiltration in early responses (12-24 h), with structural modifications (3-14 days) and neovascularization (5-14 days) as delayed responses. Immunohistochemistry (IHC) identified angiogenesis (CD31, CD34), apoptosis (TUNEL, caspase-3, Bax/Bcl-2), and protein localization (NF-κB). Gene (PCR) and protein expression (western blot) detected inflammation and apoptosis; endoplasmic reticulum stress/oxidative stress and hypoxia; and neovascularization. The most common markers were TNF-α, IL-6 and IL-1β (inflammation), caspase-3 (apoptosis), VEGF (neovascularization), and HIF-1α (hypoxia). CONCLUSION There is no consensus or standard for reporting skin injury during ischemia and IRI. H&E histology is most frequently performed but is primarily descriptive and lacks sensitivity for early skin injury. Immunohistochemistry and gene/protein expression reveal immediate and quantitative cellular responses to skin ischemia and IRI. Future research is needed towards a universally-accepted skin injury scoring system.
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Affiliation(s)
- Ryan Khalaf
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jose Reyes
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Najafali
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Wang M, Zhan H, Wang J, Song H, Sun J, Zhao G. Calcium silicate-stimulated adipose-derived stem cells promote angiogenesis and improve skin wound healing. Aging (Albany NY) 2023; 15:204760. [PMID: 37263631 DOI: 10.18632/aging.204760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
Skin wound healing is a complicated process involving proliferation, inflammation, coagulation, and hemostasis, and scar tissue formation of wound repairing. Adipose-derived stem cells (ADSCs) have presented potential therapeutic effects in the non-healing and chronic wound. Calcium silicate (CS) ceramics have been identified as a new type of bioceramics for tissue construction and regeneration. Here, we aimed to explore the impact of CS on the regulation of ADSCs-mediated wound healing. Significantly, CS was able to dose-dependently enhance the proliferation of ADSCs. CS inhibited terminal deoxynucleotidyl transferase dUTP nick end labeling positive cells in the H2O2-treated ADSCs. Similarly, the Bcl-2 expression was elevated while Bax and cleaved caspase-3 expression were repressed by CS in the cells. CS could induce migration and reduce oxidative stress of ADSCs. Moreover, immunofluorescence analysis and Western blot analysis showed that CS could promote CXCR4 expression in ADSCs. Moreover, CS-stimulated ADSCs enhanced migration and angiogenic capacity of HUVEC. Importantly, CS-stimulated ADSCs improved wound healing in full-thickness skin defect mouse model. Thus, we conclude that CS improves ADSCs-attenuated wound healing in vivo and in vitro. Our finding presents novel insight in the scenario that CS regulates ADSCs and wound healing. CS may be applied as potential materials for the treatment of wound healing.
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Affiliation(s)
- Mingming Wang
- Department of Orthopaedics, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopaedics, Tengzhou Central People’s Hospital, Tengzhou, Shandong, China
| | - Hongyan Zhan
- Department of B-Ultrasound, The Fourth People’s Hospital of Jinan, Jinan, Shandong, China
| | - Jianhua Wang
- Department of Orthopaedics, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopaedics, Tengzhou Central People’s Hospital, Tengzhou, Shandong, China
| | - Hua Song
- Department of Orthopaedics, Tengzhou Central People’s Hospital, Tengzhou, Shandong, China
| | - Jianhua Sun
- Department of Orthopaedics, Tengzhou Central People’s Hospital, Tengzhou, Shandong, China
| | - Gang Zhao
- Department of Orthopaedics, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Yang K, Wang X, Sun Y, Xiong X, Meng X, Fang B, Li W, Yi Z. MiR-590-3p affects the function of adipose-derived stem cells (ADSCs) on the survival of skin flaps by targeting VEGFA. Regen Ther 2022; 21:322-330. [PMID: 36110972 PMCID: PMC9463178 DOI: 10.1016/j.reth.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/28/2022] [Accepted: 07/23/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Partial necrosis of skin flaps is still a substantial problem in plastic and reconstructive surgery. In this study, the role of miR-590-3p in adipose-derived stem cells (ADSCs) transplantation in improving the survival of skin flap in a mouse model was delved into. Method An abdominal perforator flap model was established in mice. The histopathological examination of mice skin tissues after ADSCs transplantation was implemented using Hematoxylin & eosin (H&E) staining. Immunohistochemistry (IHC) or immunofluorescence (IF) staining was utilized to assess the PCNA or CD31 levels. The concentrations of VEGFA in the culture medium were quantified using a VEGFA ELISA kit. Result The damage of tissue in the skin flap was dramatically relieved by ADSCs transplantation. MiR-590-3p overexpression notably suppressed, while miR-590-3p knockdown facilitated skin flap survival by regulating PCNA, VCAM-1, and VEGFA levels. MiR-590-3p targeted VEGFA to regulate its expression. The knockdown of VEGFA significantly inhibited, while overexpression of VEGFA notably promoted the survival of skin flap. Conclusion ADSCs transplantation promotes skin flap survival by boosting angiogenesis. The miR-590-3p/VEGFA axis modulates skin flap angiogenesis and survival in ADSCs. These results reveal that interfering with miR-590-3p in ADSCs could potentially be a novel therapeutic target for the improvement of skin flap survival. ADSCs transplantation improve perforator flap survival. Agomir-590-3p transfected ADSCs inhibited perforator flap survival. MiR-590-3p targeted VEGFA 3′UTR to regulate its expression. The miR-590-3p/VEGFA axis in ADSCs modulates skin flap angiogenesis.
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Affiliation(s)
- Kai Yang
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiancheng Wang
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yang Sun
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiang Xiong
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xianxi Meng
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Bairong Fang
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Wenbo Li
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhongjie Yi
- Department of Plastic Surgery and Burns Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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Kuroki T, Takekoshi S, Kitatani K, Kato C, Miyasaka M, Akamatsu T. Protective Effect of Ebselen on Ischemia-reperfusion Injury in Epigastric Skin Flaps in Rats. Acta Histochem Cytochem 2022; 55:149-157. [PMID: 36405551 PMCID: PMC9631984 DOI: 10.1267/ahc.22-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to determine the role of oxidized diacylglycerol (DAG) and the molecular mechanism underlying ischemia-reperfusion (I/R) injury in rat skin flaps. The protective effect of ebselen on the viability of rat skin flaps with I/R injury was investigated. Flaps were designed and raised in the left inguinal region. Then, a microvascular clamp was applied to the vascular pedicle and reperfused after 6 hr. After 7 days of I/R (I/R group), the skin flap survival area ratio was significantly reduced compared to the normal skin. The administration of ebselen significantly improved the ratio compared to the I/R group. The flap survival area ratio of the I/R + ebselen group was significantly improved compared to the I/R + vehicle group. In the I/R + ebselen group, the oxidized DAG content and intensity of phosphorylated PKCα and PKCδ were significantly lower compared to the I/R + vehicle group. Furthermore, the inflammatory response was suppressed in the I/R + ebselen group compared to the I/R + vehicle group. These results indicate that ebselen is useful as a preventive and therapeutic agent for skin flap necrosis caused by I/R, because of reduction and elimination of oxidized DAG.
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Affiliation(s)
- Takahiko Kuroki
- Department of Plastic Surgery, Tokai University School of Medicine
| | - Susumu Takekoshi
- Department of Cell Biology, Division of Host Defense Mechanism, Tokai University School of Medicine
| | - Kanae Kitatani
- Support Center of Medical Research and Education, Tokai University School of Medicine
| | - Chikara Kato
- Department of Cell Biology, Division of Host Defense Mechanism, Tokai University School of Medicine
| | - Muneo Miyasaka
- Department of Plastic Surgery, Tokai University School of Medicine
| | - Tadashi Akamatsu
- Department of Plastic Surgery, Tokai University School of Medicine
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5
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Lee JH, You HJ, Lee TY, Kang HJ. Current Status of Experimental Animal Skin Flap Models: Ischemic Preconditioning and Molecular Factors. Int J Mol Sci 2022; 23:5234. [PMID: 35563624 PMCID: PMC9103896 DOI: 10.3390/ijms23095234] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Skin flaps are necessary in plastic and reconstructive surgery for the removal of skin cancer, wounds, and ulcers. A skin flap is a portion of skin with its own blood supply that is partially separated from its original position and moved from one place to another. The use of skin flaps is often accompanied by cell necrosis or apoptosis due to ischemia-reperfusion (I/R) injury. Proinflammatory cytokines, such as nuclear factor kappa B (NF-κB), inhibitor of kappa B (IκB), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and oxygen free radicals are known causative agents of cell necrosis and apoptosis. To prevent I/R injury, many investigators have suggested the inhibition of proinflammatory cytokines, stem-cell therapies, and drug-based therapies. Ischemic preconditioning (IPC) is a strategy used to prevent I/R injury. IPC is an experimental technique that uses short-term repetition of occlusion and reperfusion to adapt the area to the loss of blood supply. IPC can prevent I/R injury by inhibiting proinflammatory cytokine activity. Various stem cell applications have been studied to facilitate flap survival and promote angiogenesis and vascularization in animal models. The possibility of constructing tissue engineered flaps has also been investigated. Although numerous animal studies have been published, clinical data with regard to IPC in flap reconstruction have never been reported. In this study, we present various experimental skin flap methods, IPC methods, and methods utilizing molecular factors associated with IPC.
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Affiliation(s)
- Ju-Hee Lee
- College of Korean Medicine, Dongguk University, Goyang 10326, Korea;
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University Ansan Hospital, Ansan 15355, Korea; (H.-J.Y.); (T.-Y.L.)
| | - Tae-Yul Lee
- Department of Plastic Surgery, Korea University Ansan Hospital, Ansan 15355, Korea; (H.-J.Y.); (T.-Y.L.)
| | - Hyo Jin Kang
- Biomedical Research Center, Korea University Ansan Hospital, Ansan 15355, Korea
- Core Research and Development Center, Korea University Ansan Hospital, Ansan 15355, Korea
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Kilic F, Eskitascioglu T, Aydin A, Cakici OU. Ameliorating Effects of β-Glucan on Epigastric Artery Island Flap Ischemia-Reperfusion Injury. J Surg Res 2021; 261:282-292. [PMID: 33477077 DOI: 10.1016/j.jss.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury has been one of the culprits of tissue injury and flap loss after island flap transpositions. Thus, significant research has been undertaken to study how to prevent or decrease the spread of ischemia-reperfusion injury. Preventive effects of β-glucan on ischemia-reperfusion injury in the kidney, lung, and small intestine have previously been reported. In this study, we present the ameliorating effects of β-glucan on ischemia-reperfusion injury using the epigastric artery island-flap in rats. MATERIALS AND METHODS Thirty Wistar-Albino rats were equally divided into three groups: sham, experimental model, and treatment groups. In the sham group, an island flap was elevated and sutured back to the original position without any ischemia. In the experimental model group, the same-sized flap was elevated and sutured back with 8 h of ischemia and consequent 12 h of reperfusion. In the treatment group, 50 mg per kilogram β-glucan was administered to the rats using an orogastric tube for 10 d before the experiment. The same-sized flap is elevated and sutured back to its original position with 8 h of ischemia and 12 h of consequent reperfusion in the treatment group. Tissue biopsies were taken on the first day of the experimental surgery. Tissue neutrophil aggregation and vascular responses were evaluated by histological examinations. Tissue oxidant and antioxidant enzyme levels are evaluated biochemically after tissue homogenization. Topographic follow-up and evaluation of the flaps were maintained, and photographs were taken on the first and seventh day of the experimental surgery. RESULTS Topographic flap survival was significantly better in the β-glucan administered group. The neutrophil number, malondialdehyde, and myeloperoxidase levels were significantly lower while glutathione peroxidase and superoxide dismutase levels were significantly higher in the β-glucan administered group respective to the experimental model group. CONCLUSIONS Based on the results of our study, we can conclude that β-glucan is protective against ischemia-reperfusion injury. Our study presents the first experimental evidence of such an effect on skin island flaps.
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Affiliation(s)
- Fatih Kilic
- Department of Aesthetic Plastic and Reconstructive Surgery, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Teoman Eskitascioglu
- Department of Aesthetic Plastic and Reconstructive Surgery, Memorial Hospital, Kayseri, Turkey
| | - Ahmet Aydin
- Department of Aesthetic Plastic and Reconstructive Surgery, Bagcilar Medipol Mega University Hospital, Istanbul, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Yuksek Ihtisas University, Ankara, Turkey.
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Zheng Y, Li Z, Yin M, Gong X. Heme oxygenase‑1 improves the survival of ischemic skin flaps (Review). Mol Med Rep 2021; 23:235. [PMID: 33537805 PMCID: PMC7893698 DOI: 10.3892/mmr.2021.11874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/12/2021] [Indexed: 01/17/2023] Open
Abstract
Heat shock protein 32 (Hsp32), also known as heme oxygenase‑1 (HO‑1), is an enzyme that exists in microsomes. HO‑1 can be induced by a variety of stimuli, including heavy metals, heat shock, inflammatory stimuli, heme and its derivatives, stress, hypoxia, and biological hormones. HO‑1 is the rate‑limiting enzyme of heme catabolism, which splits heme into biliverdin, carbon monoxide (CO) and iron. The metabolites of HO‑1 have anti‑inflammatory and anti‑oxidant effects, and provide protection to the cardiovascular system and transplanted organs. This review summarizes the biological characteristics of HO‑1 and the functional significance of its products, and specifically elaborates on its protective effect on skin flaps. HO‑1 improves the survival rate of ischemic skin flaps through anti‑inflammatory, anti‑oxidant and vasodilatory effects of enzymatic reaction products. In particular, this review focuses on the role of carbon monoxide (CO), one of the primary metabolites of HO‑1, in flap survival and discusses the feasibility and existing challenges of HO‑1 in flap surgery.
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Affiliation(s)
- Yinhua Zheng
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhenlan Li
- Department of Rehabilitation Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Min Yin
- Department of Nephrology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Li Y, Jiang QL, Van der Merwe L, Lou DH, Lin C. Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis. Stem Cell Res Ther 2021; 12:28. [PMID: 33413598 PMCID: PMC7791712 DOI: 10.1186/s13287-020-02103-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.
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Affiliation(s)
- Yuan Li
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Nan Bai Xiang, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Qi-Lin Jiang
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Nan Bai Xiang, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Leanne Van der Merwe
- School of International Studies, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Dong-Hao Lou
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Nan Bai Xiang, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Cai Lin
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Nan Bai Xiang, Wenzhou, Zhejiang, 325000, People's Republic of China.
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9
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Pak CS, Moon SY, Lee YE, Kang HJ. Therapeutic Effects against Tissue Necrosis of Remote Ischemic Preconditioning Combined with Human Adipose-Derived Stem Cells in Random-Pattern Skin Flap Rat Models. J INVEST SURG 2020; 34:1304-1311. [PMID: 32691637 DOI: 10.1080/08941939.2020.1795750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Remote ischemic preconditioning (rIPC) is a preventive strategy against ischemia-reperfusion injury. To reduce ischemia-reperfusion injury of random-pattern skin flaps, we investigated the therapeutic effects of rIPC combined with human adipose-derived stem cells (hADSCs) in a rat model. MATERIAL AND METHODS In total, 24 female Sprague Dawley rats were divided into four groups (n = 6 each): control (skin flap only), rIPC, hADSCs, and rIPC + hADSCs. rIPC was performed in the hind limb of the rats over three cycles of 5 min of occlusion and 5 min of reperfusion, using a tourniquet. A rectangular (3 × 9 cm) dorsal skin flap was used. hADSCs (5 × 105 cells/100 µL) labeled with fluorescent dye were transplanted into the normal subcutaneous tissue at the skin flap boundary. After 14 days, the therapeutic effects of rIPC and hADSCs were evaluated via analysis of the necrotic flap area, histopathologic assessment, and immunohistochemistry (von Willebrand Factor (vWF) and CD31). RESULTS The necrotic area of the skin flap significantly decreased in the rIPC + hADSCs group (32.75 ± 1.43%) compared with the control (40.60 ± 3.27%, P < 0.01) and rIPC groups (38.84 ± 0.77%, P < 0.05). Dye-labeled hADSCs migrated to the skin flap from the injection site. In the rIPC + hADSCs group, the epithelial tissue and skin appendage had regenerated, and the smooth muscle and subcutaneous fat layers were preserved. Many more vWF- and CD31-positive vessels were observed in the rIPC + hADSCs group compared with the other groups. CONCLUSIONS The rIPC + hADSCs treatment appeared to reduce skin flap necrosis and activated neovascularization in rats. Therefore, it may be a good strategy for clinical treatment of ischemia-reperfusion injury.
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Affiliation(s)
- Chang Sik Pak
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea.,Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Young Moon
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Korea
| | - Young Eun Lee
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jin Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea.,Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Korea
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10
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Zhang Z, Hou Y, Li J, Tang C, Que L, Tan Q, Li Y. TIR/BB-loop mimetic AS-1 protects vascular endothelial cells from injury induced by hypoxia/reoxygenation. J Biomed Res 2019; 34:343-350. [PMID: 32594023 PMCID: PMC7540235 DOI: 10.7555/jbr.33.20190030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Morphological and functional abnormalities of vascular endothelial cells (VECs) are risk factors of ischemia-reperfusion in skin flaps. Signaling pathway mediated by interleukin-1 receptor (IL-1R) is essential to hypoxia/reoxygenation (H/R) injury of VECs. While the TIR/BB-loop mimetic (AS-1) disrupts the interaction between IL-1R and myeloid differentiation primary-response protein 88 (MyD88), its role in the VECs dysfunction under H/R is unclear. In this study, we first showed that there was an infiltration of inflammatory cells and the apoptosis of VECs by using a skin flap section from patients who received flap transplantation. We then showed that the H/R treatment induced apoptosis and loss of cell migration of endothelial cell line H926 were attenuated by AS-1. Furthermore, our data suggested that AS-1 inhibits the interaction between IL-1R and MyD88, and subsequent phosphorylation of IκB and p38 pathway, as well as the nuclear localization of NF-KB subunit p65/p50. Thus, this study indicated that the protective role of AS-1 in H/R induced cellular injury may be due to the AS-1 mediated down-regulation of IL-1R signaling pathway.
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Affiliation(s)
- Zhijia Zhang
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China.,Department of Plasticsurgery, Drum Tower Hospital, Nanjing, Jiangsu 211100, China
| | - Yuxing Hou
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Jiantao Li
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Chao Tang
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Linli Que
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Qian Tan
- Department of Plasticsurgery, Drum Tower Hospital, Nanjing, Jiangsu 211100, China
| | - Yuehua Li
- Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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11
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Han HH, Min KH. Is split-thickness skin graft safe for coverage of the vascular pedicle in free tissue transfer? J Plast Surg Hand Surg 2019; 53:138-142. [PMID: 30676836 DOI: 10.1080/2000656x.2018.1547737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION If the pedicle is compressed after microanastomosis during free flap reconstruction, additional tissue such as skin graft or vascularized flap is needed to avoid tension. Performing a skin graft directly on the vessel might cause considerable problems. We aimed to analyze the safety of skin grafting on the anastomosis site of the free flap. PATIENTS AND METHODS A total of 15 patients who underwent skin grafting on the anastomosis site were analyzed. The skin graft take-up rate and flap-related complications were evaluated postoperatively. RESULTS All involved sites were the extremities (10 hands and 5 feet). An anterolateral thigh free flap in six patients and a toe pulp free flap in nine patients were harvested. The mean follow-up period was 10.4 ± 6.2 months. The graft area for the pedicle was 2.8 ± 1.6 cm2. The percentage of final graft take was 99.3 ± 1.2% at 30 days postoperatively without flap compromise. CONCLUSION During free flap surgery in the upper or lower extremities, inadequate pedicle coverage may occur easily. Applying a split-thickness skin graft in such cases can be safe and one of the simple methods.
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Affiliation(s)
- Hyun Ho Han
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Kyung Hyun Min
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
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Ballestín A, Casado JG, Abellán E, Vela FJ, Álvarez V, Usón A, López E, Marinaro F, Blázquez R, Sánchez-Margallo FM. Ischemia-reperfusion injury in a rat microvascular skin free flap model: A histological, genetic, and blood flow study. PLoS One 2018; 13:e0209624. [PMID: 30589864 PMCID: PMC6307726 DOI: 10.1371/journal.pone.0209624] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 12/29/2022] Open
Abstract
Ischemia reperfusion injury is associated with tissue damage and inflammation, and is one of the main factors causing flap failure in reconstructive microsurgery. Although ischemia-reperfusion (I/R) injury is a well-studied aspect of flap survival, its biological mechanisms remain to be elucidated. To better understand the biological processes of ischemia reperfusion injury, and to develop further therapeutic strategies, the main objective of this study was to identify the gene expression pattern and histological changes in an I/R injury animal model. Fourteen rats (n = 7/group) were randomly divided into control or ischemia-reperfusion group (8 hours of ischemia). Microsurgical anastomoses were objectively assessed using transit-time-ultrasound technology. Seven days after surgery, flap survival was evaluated and tissue samples were harvested for anatomopathological and gene-expression analyses.The I/R injury reduced the survival of free flaps and histological analyses revealed a subcutaneous edema together with an inflammatory infiltrate. Interestingly, the Arginase 1 expression level as well as the ratio of Arginase 1/Nitric oxide synthase 2 showed a significant increase in the I/R group. In summary, here we describe a well-characterized I/R animal model that may serve to evaluate therapeutic agents under reproducible and controlled conditions. Moreover, this model could be especially useful for the evaluation of arginase inhibitors and different compounds of potential interest in reconstructive microsurgery.
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Affiliation(s)
- Alberto Ballestín
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
- * E-mail:
| | - Javier G. Casado
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Elena Abellán
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - F. Javier Vela
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Verónica Álvarez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Alejandra Usón
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Esther López
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Federica Marinaro
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Rebeca Blázquez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco Miguel Sánchez-Margallo
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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Guo K, Ma J, Liang W. Effects of SB202190 on expression levels of IL-6 and NF-κB in flap ischemia-reperfusion injury. Exp Ther Med 2018; 16:2522-2526. [PMID: 30210603 PMCID: PMC6122530 DOI: 10.3892/etm.2018.6442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/25/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of the current study was to investigate the effect of SB202190, a specific inhibitor of p38 MAPK signaling pathway, on the expression levels of IL-6 and NF-κB in flap ischemia-reperfusion injury. Healthy Sprague-Dawley rats were randomly divided into four groups of 12 each. For the ischemia-reperfusion group, the flap was constructed and then sutured after 8 h of ischemia. For the saline group, rats were intraperitoneally infused with saline at regular intervals after flap ischemia-reperfusion. For the inhibitor group, rats were intraperitoneally infused with SB202190 at regular intervals after flap ischemia-reperfusion. For the control group, the flap was constructed and then sutured immediately. The flap survival rate of each group was measured after 7 days. The concentration of IL-6 in serum was measured by ELISA kit. The mRNA and protein expression levels of IL-6 and NF-κB in the flap were measured using RT-PCR and western blot analysis, respectively. In the ischemia-reperfusion group and the saline group, the flap survival rates were much lower than that in the control group (P<0.05). By contrast, the mRNA and protein expression levels of IL-6 and NF-κB in the flap and the concentration of IL-6 in serum were much higher (P<0.05). In the inhibitor group, the flap survival rate was significantly higher than those in the ischemia-reperfusion and saline groups (P<0.05). By contrast, the concentration of IL-6 in serum and the mRNA and protein expression levels of NF-κB and IL-6 in the flap were significantly decreased (P<0.05). The results show that, SB202190 played a role in the protection of the flap by reducing the inflammatory response in flap ischemia-reperfusion injury.
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Affiliation(s)
- Kai Guo
- Department III of Orthopaedics, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, P.R. China
| | - Jingxin Ma
- Department of Spine Surgery, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, P.R. China
| | - Wenyong Liang
- Department of Hand, Foot and Ankle Surgery, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
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Li J, Wu B, Teng D, Sun X, Li J, Li J, Zhang G, Cai J. Cobalt-protoporphyrin enhances heme oxygenase 1 expression and attenuates liver ischemia/reperfusion injury by inhibiting apoptosis. Mol Med Rep 2018; 17:4567-4572. [PMID: 29328470 DOI: 10.3892/mmr.2018.8384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the preconditioning effect and underlying mechanisms of cobalt-protoporphyrin (CoPP) in a mouse model of liver ischemia‑reperfusion (I/R) injury. Mice were divided into five groups: Sham‑operated (control), I/R, I/R + CoPP, I/R + CoPP and zinc‑protoporphyrin (ZnPP) and I/R + ZnPP. Serum levels of aspartate transaminase (AST) and alanine aminotransferase (ALT) were detected using commercial kits. The expression of the pro‑apoptotic protein caspase‑3 was detected by immunohistochemistry and the expression levels of the anti‑apoptotic protein B‑cell lymphoma 2 (Bcl‑2) and heme oxygenase 1 (HO‑1) were analyzed by western blotting. Sections of liver tissue were stained with hematoxylin and eosin to observe pathologic alterations. Furthermore, hepatocyte apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. AST and ALT levels of the CoPP preconditioned group were significantly reduced compared with the IR injury group (P<0.05) and liver damage was attenuated. The expression levels of the pro‑apoptotic protein caspase3 was inhibited and those of HO‑1 and Bcl‑2 were increased in the CoPP group compared with the I/R group; the opposite results were observed in the ZnPP group. Furthermore, the percentage of apoptotic cells as detected by TUNEL was significantly decreased in the CoPP group compared with the I/R group (P<0.05); these protective effects were abrogated by ZnPP. In conclusion, the results of the present study suggested that CoPP may induce HO‑1 overexpression and produce anti‑apoptotic effects in liver I/R injury.
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Affiliation(s)
- Jing Li
- Departments of Transplantation and Gastroenterology, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Bin Wu
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Dahong Teng
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Xiaoye Sun
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Junjie Li
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Jiang Li
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Guoliang Zhang
- Department of Gastroenterology, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
| | - Jinzhen Cai
- Department of Transplantation, Tianjin First Central Hospital of Tianjin Medical University, Tianjin 300192, P.R. China
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Adipose Tissue Drives Response to Ischemia-Reperfusion Injury in a Murine Pressure Sore Model. Plast Reconstr Surg 2017; 139:1128e-1138e. [PMID: 28445367 DOI: 10.1097/prs.0000000000003271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury contributes significantly to the pathogenesis of chronic wounds such as pressure sores and diabetic foot ulcers. The authors' laboratory has previously developed a cyclical murine ischemia-reperfusion injury model. The authors here use this model to determine factors underlying tissue response to ischemia-reperfusion injury. METHODS C57BL/6 mice were subjected to cycles of ischemia-reperfusion that varied in number (one to four cycles) and duration of ischemia (1 to 2 hours). For each ischemia-reperfusion condition, the following variables were analyzed: (1) digital photographs for area of necrosis; (2) hematoxylin and eosin staining and immunohistochemistry for inflammatory infiltrate; and (3) expression of inflammatory markers by quantitative polymerase chain reaction. In addition, human adipocytes and fibroblasts were cultured in vitro under conditions of hypoxia and reoxygenation, and expression of inflammatory markers was analyzed by quantitative polymerase chain reaction. RESULTS Increases in both ischemia-reperfusion cycle number and ischemia duration correlated with increased areas of epithelial necrosis both grossly and histologically, and with an increase in cellularity and neutrophil density. This increased inflammatory infiltrate and a significant increase in the expression of proinflammatory markers (Hmox1, interleukin-6, interleukin-1, and monocyte chemoattractant protein-1) was observed in adipose tissue subjected to ischemia-reperfusion injury, but not in dermis. These results were mirrored in human adipose tissue. CONCLUSIONS The authors further characterize a novel, reproducible murine model of ischemia-reperfusion injury. The results of their study indicate that adipose tissue is less tolerant of ischemia-reperfusion than dermal tissue. Rather than being an "innocent bystander," adipose tissue plays an active role in driving the inflammatory response to ischemia-reperfusion injury.
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Leng X, Fan Y, Wang Y, Sun J, Cai X, Hu C, Ding X, Hu X, Chen Z. Treatment of Ischemia-Reperfusion Injury of the Skin Flap Using Human Umbilical Cord Mesenchymal Stem Cells (hUC-MSCs) Transfected with "F-5" Gene. Med Sci Monit 2017; 23:2751-2764. [PMID: 28586321 PMCID: PMC5469319 DOI: 10.12659/msm.905216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Recent studies have shown that skin flap transplantation technique plays an important role in surgical procedures. However, there are many problems in the process of skin flap transplantation surgeries, especially ischemia-reperfusion injury, which directly affects the survival rate of the skin flap and patient prognosis after surgeries. Material/Methods In this study, we used a new method of the “stem cells-gene” combination therapy. The “F-5” gene fragment of heat shock protein 90-α (Hsp90-α) was transfected into human umbilical cord mesenchymal stem cells (hUC-MSCs) by genetic engineering technique. Results The synergistic effects of “F-5” gene and hUC-MSCs in the treatment of ischemia-reperfusion injury of the skin flap were confirmed by histochemical and immunohistochemical methods. Conclusions This study showed that the hUC-MSCs transfected with “F-5” gene can effectively improve the repair of ischemia-reperfusion injury.
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Affiliation(s)
- Xiangfeng Leng
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Yongle Fan
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Yating Wang
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Jian Sun
- Department of Nephrology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Xia Cai
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Chunnan Hu
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | | | - Xiaoying Hu
- The Eighth People's Hospital of Qingdao, Qingdao, Shandong, China (mainland)
| | - Zhengyu Chen
- Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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