Fibrin-Embedded Adipose Derived Stem Cells Enhance Skin Flap Survival

Abstract

Surgical skin flaps are frequently used procedures in plastic and reconstructive surgery to cover acquired or congenital defects. Either partial or total skin flap loss is a common complication, as survival of the skin flaps is determined by tissue ischemia because of insufficient vascularity. To address this issue, a number of strategies have been described to enhance blood supply and to increase skin flap survival [1–3]. Among these, stem cell-based therapies play an increasing role, due to their capacity to self-renew and differentiate into a variety of specific cell lines. Especially adipose -derived stem cells (ADSCs)—therapies have raised tremendous interest in the field of soft tissue reconstruction as they offer distinct advantages over bone marrow-derived stem cells [4]. ADSCs can be easily harvested in a minimal invasive procedure, found in abundant quantities and have the ability to differentiate into osteoblasts, chondrocytes and adipocytes in controllable and reproducible manner [5–7]. With regard to plastic and reconstructive surgery perspectives, ADSCstherapy has recently been demonstrated to improve skin flap survival [8–14]. Further investigations documented a positive effect of rescuing ischemic skin flaps by increasing tissue perfusion, a significant rise of growth factors such as vascular endothelial growth factor (VEGF) as well as fibroblast growth factor (FGF) after ADSCtherapy in rodent model [8, 10–13]. However, in all these studies ADSCs were injected into the subcutaneous tissue which may result in an uncertain distribution of the ADSCs. Furthermore the purity of the applied stem cells was not clearly analyzed. In light of these recent results this study was designed to firstly isolate and cultivate rat adipose derived stem cells and secondly determine the potential of locally applied fibrinembedded ADSCs to enhance skin flap survival in an animal epigastric skin flap model.