Abstract
BackgroundIn plastic surgery, skin flap is an important approach to reconstructive wound repairs. The rat dorsal skin flap is a clinically relevant and popular animal model to investigate and evaluate flap survival and necrosis. Nonetheless, flap survival is often unstable with unpredictable outcomes, regardless of previous attempts at design modification.Methods & ResultsIn the present study, we report a novel flap chamber that provides stable and reproducible outcomes by separating the dorsal skin flap from its surrounding skin by in situ immobilization. The flap chamber blocks circulation that disturbs flap ischemia from both basal and lateral sides of the flap tissue. Demarcation of skin necrosis is macroscopically evident on the flap and supported by distinct changes in histological architecture under microscopic examination. The utility of the novel skin flap chamber is further proven by applying it to the examination of flap survival in streptozotocin-induced diabetic rats with an increase in skin necrosis. The flap chamber also affords size modifications where a narrower flap chamber increases ischemia and provides manipulable therapeutic windows for studying cell therapies. Accordingly, intradermal injection of endothelial cells 3 days before flap ischemia significantly increases the survival of skin flaps.ConclusionsThe novel flap chamber not only may stabilize the skin flap and provide reproducible outcomes that overcome the shortfalls of the traditional ischemic flap but also may afford size modifications that support research designs and test therapeutic approaches to regenerative repair.Electronic supplementary materialThe online version of this article (doi:10.1186/s13287-016-0333-0) contains supplementary material, which is available to authorized users.
Highlights
Surgical skin flaps are often used to repair wounds resulting from trauma, congenital defects, tumor excision, or other causes
To minimize the unpredictability of dorsal skin flap necrosis, we introduce an innovative flap chamber and verify its reproducibility in both healthy and disease models, including therapeutic approaches
The contraction of the flap was present in most cases of the McFarlane flap and exhibited variable distorted patterns with different degrees of flap necrosis
Summary
Surgical skin flaps are often used to repair wounds resulting from trauma, congenital defects, tumor excision, or other causes. Partial skin flap necrosis is a common problem in the clinic, especially at the distal part of the flap [1]. Flap necrosis is caused primarily by inadequate blood perfusion or ischemia-reperfusion and induces several detrimental changes in the tissue and vasculature, such as reactive oxygen species and superoxide dismutase activities [2]. Common ischemic factors such as poor surgical technique and handling, smoking, and diabetes mellitus may jeopardize skin flap survival. Skin flap is an important approach to reconstructive wound repairs. Flap survival is often unstable with unpredictable outcomes, regardless of previous attempts at design modification
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