Patrick Rhodius1, Anthony Haddad1, Hajime Matsumine1, Dharaniya Sakthivel1, Maximilian Ackermann1, Indranil Sinha1, Dennis P Orgill1, Giorgio Giatsidis1. 1. From the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; the Department of Plastic and Reconstructive Surgery, Hand Surgery-Burn Center, University Hospital of the RWTH Aachen; the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University; and the Institute of Pathology, Heinrich Heine University and University Hospital.
Abstract
BACKGROUND: Advances in reconstructive surgery are leading to an increased number of flaps at risk for ischemic necrosis, because of either intrinsic (e.g., larger flap size) or extrinsic (e.g., diabetes) factors. Methods to preoperatively improve flap vascularity and limit postoperative ischemia are lacking. Noninvasive suction, using either a macrodeformational silicone cup interface (external volume expansion) or a microdeformational polyurethane foam interface (foam-mediated external volume expansion), has been shown to induce angiogenesis in tissues. The authors investigated whether the preoperative use of external volume expansion/foam-mediated external volume expansion improves flap survival in an obesity-induced diabetic animal model. METHODS: Db/Db mice underwent either mechanical stimulation with suction for 5 days using either external volume expansion or foam-mediated external volume expansion, or received no stimulation (n = 8 per group). Five days after the last stimulation, a critical-size, axial-pattern, fasciocutaneous flap was raised in all animals. Postoperatively, flap survival was monitored with digital imaging for 10 days. After this period, flaps were harvested to assess tissue survival, angiogenesis, and inflammation, using histology and polymerase chain reaction. RESULTS: Foam-mediated external volume expansion preconditioning significantly increased the viable flap area (28 percent), viable flap volume (27 percent), and flap capillary density (36 percent) in comparison to controls; vascular endothelial growth factor was also up-regulated (>300 percent). In contrast, external volume expansion resulted in a severe inflammatory response and increased flap necrosis. CONCLUSIONS: Foam-mediated external volume expansion improves flap survival in obese diabetic mice. This procedure may allow for improved clinical rates of flap survival in high-risk patients.
BACKGROUND: Advances in reconstructive surgery are leading to an increased number of flaps at risk for ischemic necrosis, because of either intrinsic (e.g., larger flap size) or extrinsic (e.g., diabetes) factors. Methods to preoperatively improve flap vascularity and limit postoperative ischemia are lacking. Noninvasive suction, using either a macrodeformational silicone cup interface (external volume expansion) or a microdeformational polyurethane foam interface (foam-mediated external volume expansion), has been shown to induce angiogenesis in tissues. The authors investigated whether the preoperative use of external volume expansion/foam-mediated external volume expansion improves flap survival in an obesity-induced diabetic animal model. METHODS: Db/Db mice underwent either mechanical stimulation with suction for 5 days using either external volume expansion or foam-mediated external volume expansion, or received no stimulation (n = 8 per group). Five days after the last stimulation, a critical-size, axial-pattern, fasciocutaneous flap was raised in all animals. Postoperatively, flap survival was monitored with digital imaging for 10 days. After this period, flaps were harvested to assess tissue survival, angiogenesis, and inflammation, using histology and polymerase chain reaction. RESULTS: Foam-mediated external volume expansion preconditioning significantly increased the viable flap area (28 percent), viable flap volume (27 percent), and flap capillary density (36 percent) in comparison to controls; vascular endothelial growth factor was also up-regulated (>300 percent). In contrast, external volume expansion resulted in a severe inflammatory response and increased flap necrosis. CONCLUSIONS: Foam-mediated external volume expansion improves flap survival in obese diabeticmice. This procedure may allow for improved clinical rates of flap survival in high-risk patients.
Authors: Anita T Mohan; Lin Zhu; Gregory J Michalak; Alexis T Laungani; Andrew J Vercnocke; Steven L Moran; Michel Saint-Cyr Journal: Plast Reconstr Surg Glob Open Date: 2020-08-18
Authors: Francisco R Avila; Ricardo A Torres-Guzman; María T Huayllani; Gunel Guliyeva; Abba C Zubair; Alfredo Quiñones-Hinojosa; Antonio J Forte; Rachel Sarabia-Estrada Journal: J Clin Transl Res Date: 2022-03-01