Skin Flap's Viability Improvement after Erythropoietin Injection on Extended Random Skin Flap Model in Wistar Rats

Abstract

Introduction: Wound defect closure using flaps has advanced in many areas, as have the methods to increase its viability. Erythropoietin (EPO) is a glycoprotein produced by the kidney for erythrocyte production. EPO has the ability to stabilize vascular integrity, increase endothelium cells, protect cells from ischemia and apoptosis, stimulate angiogenesis, and reduce inflammation. The aim of this study is to evaluate flap viability for an extended random skin flap. Methods: In a randomized posttest only control group design experiment, thirty male Wistar strain rats (Rattus norvegicus) divided into groups of ten rats with flap model of 2 cm × 8 cm were injected with EPO in the middle of the flap. Group 1 was injected with EPO 50 IU, Group 2 with EPO 100 IU, and Group 3 is the control group with no injection. Flaps were evaluated on the 7th day to check the necrotic area using imitoMeasure®. Specimens were taken in the middle of the flap to evaluate the capillary vessels, and histopathology examinations were performed with hematoxylin and eosin staining. Capillary vessels and necrotic area data were analyzed using ANOVA. Results: The amount of capillary vessels in the random skin flap showed significant differences between 50 IU Group, 100 IU Group, and control group (P = 0.000). The Necrotic area measured in the random skin flap also showed significant differences between 50 IU group and control group (P = 0.020), whereas, 100 IU group compared to the control group showed no significant difference (P = 0.680). Conclusion: EPO 50 IU injection showed significant differences compared to control and EPO 100 IU injection for maintaining flap viability. EPO could be a modality to enhance flap viability.