Hypoxia Preconditioning Enhances the Viability of ADSCs to Increase the Survival Rate of Ischemic Skin Flaps in Rats
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Hypoxia Preconditioning Enhances the Viability of ADSCs to Increase the Survival Rate of Ischemic Skin Flaps in Rats Yeli Yue • Peipei Zhang • Dan Liu • Jenny F. Yang • Chunlei Nie • Daping Yang
Received: 5 June 2012 / Accepted: 4 September 2012 / Published online: 12 December 2012 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2012
Abstract Use of a skin flap has been a common technique in reconstructive surgery for more than five decades. However, partial necrosis of its distal end is still a serious postoperative complication. Many theories about this problem have been proposed, including deficient blood supply, which is the most accepted theory. In this study we demonstrated that hypoxic preconditioning enhanced the viability of adipose-derived stem cells (ADSCs) in vivo and improved their ability to increase the survival rate of ischemic skin flaps in rats. Seven days after flap elevation, the flap survival rate in the hypoxic preconditioned ADSC group was higher than that in the control group. Moreover, histological examination showed that more ADSCs survived in flaps treated by hypoxic preconditioning. Vascular density in the hypoxic preconditioned ADSC group was 30–90 % greater than that in the control group. In addition, the expressions of vascular endothelial growth factor and hypoxia inducible factor-1a (HIF-1a) were higher in the hypoxic preconditioned ADSC group than in the control group (p \ 0.05). This enhancive phenomenon reached its highest level at the precondition times of 3 and 7 days in the hypoxic preconditioned ADSC group. We conclude that hypoxia preconditioning effectively enhances the viability of ADSCs to increase the survival rate of ischemic
Peipei Zhang, Yeli Yue, and Dan Liu contributed equally to this work. Y. Yue P. Zhang D. Liu J. F. Yang D. Yang (&) Department of Plastic Surgery, The Second Hospital of Harbin Medical University, Harbin 150086, China e-mail: [email protected] C. Nie Department of Head and Neck Surgery, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
skin flaps. Furthermore, 3 days is the optimal preconditioning time point. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords ADSC Hypoxia HIF-1a VEGF Skin flap survival
Introduction Surgical flaps are commonly used in plastic and reconstructive surgeries to correct defects caused by cancer excision, trauma, diabetic ulcers, and other diseases. However, flap necrosis is a serious postoperative complication. The main cause of flap necrosis is a deficient blood supply caused by surgical techniques and concomitant diseases such as diabetes mellitus, smoking, and peripheral vascular disease. To increase the blood supply to ischemic tissues, including skin flaps, i
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