Abstract
The evolution of reconstructive methods for defects of the human body cannot yet replace the use of flap surgery. Research is still preoccupied with the ideal techniques for offering the best chances of survival of the flaps. In our study, we investigated the effects of cold atmospheric plasma (CAP), N-nitro-L-arginine methyl ester (L-NAME), and platelet-rich plasma (PRP) injectable solutions on flap survival using an in vivo model. Twenty-four Wistar rats (four groups) had the McFarlane flap raised and CAP, L-NAME, and PRP substances tested through a single dose subcutaneous injection. The control group had only a saline solution injected. To the best of our knowledge, this is the first study that evaluated a CAP activated solution through injection on flaps. The flap survival rate was determined by clinical examination (photography documented), hematology, thermography, and anatomopathological tests. The image digital analysis performed on the flaps showed that the necrosis area (control—49.64%) was significantly lower for the groups with the three investigated solutions: CAP (14.47%), L-NAME (18.2%), and PRP (23.85%). Thermography exploration revealed less ischemia than the control group on the CAP, L-NAME, and PRP groups as well. Anatomopathological data noted the best degree of angiogenesis on the CAP group, with similar findings on the L-NAME and PRP treated flaps. The blood work did not indicate infection or a strong inflammatory process in any of the subjects. Overall, the study shows that the CAP activated solution has a similar (better) impact on the necrosis rate (compared with other solutions with known effects) when injected on the modified dorsal rat skin flap, and on top of that it can be obtained fast, in unlimited quantities, non-invasively, and through a standardized process.
Highlights
Until an ideal wound dressing device with synergetic effects is designed, skin flaps cannot be totally replaced, especially when a defect with vital structures exposed, such as arteries, nerves, bones, or joints, needs covering
The lowest area of necrosis was observed in the cold atmospheric plasma (CAP) group (14.47%), while for the Platelet rich plasma (PRP) group there was a percentage of necrosis of 23.85% (Figure 2—* p < 0.05; ** p < 0.01)
Intense angiogenesis processes were noticed with reduced area of necrosis and low muscular fibers destruction
Summary
Until an ideal wound dressing device with synergetic effects is designed, skin flaps cannot be totally replaced, especially when a defect with vital structures exposed, such as arteries, nerves, bones, or joints, needs covering. There have been comprehensive studies of a lot of substances that can reshape the vasculature, or they can increase survival of the modified McFarlane skin flap in rats [6,7,8,9,10,11,12,13]. This type of flap provides a very well described arterial anatomy, being a so called rando−axial flap, with a consistent vascular pedicle when caudally based and a predictable area of skin necrosis cranially [8,14,15,16]. It has been proven that it increases the viability of the flap, decreasing the area of necrosis, having pro-angiogenetic properties due to the release of factors such as vascular endothelial growth factor (VEGF) or platelet-derived angiogenesis factor (PDAF) [17,18,19]
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