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In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
Published on: June 8, 2013
The effects of botulinum toxin A on the survival of a random cutaneous flap
Taek Kyun Kim1, Eun Jung Oh, Jae Young Chung
1Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Background:
Although interest in flap surgery has increased, a satisfactory research study on supportive drugs or methods for flap surgery has not been seen in the literature thus far. Despite several studies using botulinum toxin A for flap surgery being reported, their efforts to clarify the mechanisms are not sufficient. Therefore, the authors have studied the effect of botulinum toxin A on random cutaneous flap survival in a rat model under the hypothesis that it affects the microvascular system.
Method:
Thirty 10-week-old Sprague-Dawley rats were divided into experimental (n=15) and control groups (n=15). The experimental group used 1.5 IU (International Units) of botulinum toxin A, and the control group used normal saline. A 2x8 cm random cutaneous flap was designed on the rats and then elevated. Normal saline (0.05 cc) and 1.5 IU of botulinum toxin A (0.05 cc) (Botox, Allergan, USA) were injected into the dermis layer of the central portion in the proximal one-third of the flap. Gross photographs were taken at days 1, 3, 5 and 7 after the operation. Laser-induced fluorescein fluoroscopy was performed on postoperative day 7 and tissues were retrieved for histological analysis. In addition, reverse transcriptase polymerase chain reaction (RT-PCR) was carried out for quantitative analysis.
Results:
Gross photos and laser-induced fluorescein fluoroscopy reveal the survival rate of the Botox group was 8.3% higher than the control. In the histologic study, the diameter of vessels is larger and the number of immature vessels is more in the Botox group. The result of RT-PCR shows increased expression of VEGF (vascular endothelial growth factor), CD 31 (PECAM1, platelet/endothelial cell adhesion molecule) and iNOS (inducible nitric oxide synthase), which are considered to be related to vasodilation and endothelial proliferation.
Conclusion:
Our results suggest that botulinum toxin A increases the survival rate of random cutaneous flaps by means of selective suppression of sympathetic neurons of the cutaneous microcirculation system.
Insights
Botulinum toxin A enhances random cutaneous flap survival by improving microcirculation. This study in rats showed increased flap survival and vasodilation with botulinum toxin A treatment.
Area of Science:
- Plastic Surgery
- Regenerative Medicine
- Vascular Biology
Background:
- Limited research exists on supportive therapies for flap surgery.
- The precise mechanisms of botulinum toxin A in flap surgery require further elucidation.
- This study investigates botulinum toxin A's impact on random cutaneous flap survival in a rat model, hypothesizing effects on the microvascular system.
Purpose of the Study:
- To evaluate the efficacy of botulinum toxin A in improving random cutaneous flap survival.
- To explore the underlying mechanisms of botulinum toxin A's effect on flap survival, particularly concerning the microvascular system.
Main Methods:
- A randomized controlled trial was conducted on 30 Sprague-Dawley rats, divided into experimental (botulinum toxin A) and control (saline) groups.
- Random cutaneous flaps were surgically created, and treatments were administered via dermal injection.
- Flap survival was assessed using gross photography and laser-induced fluorescein fluoroscopy, supplemented by histological analysis and RT-PCR for gene expression.
Main Results:
- The botulinum toxin A group exhibited an 8.3% higher flap survival rate compared to the control group.
- Histological examination revealed increased vessel diameter and a higher number of immature vessels in the botulinum toxin A group.
- RT-PCR analysis indicated upregulated expression of VEGF, CD 31, and iNOS, suggesting enhanced vasodilation and endothelial proliferation.
Conclusions:
- Botulinum toxin A significantly increases random cutaneous flap survival rates.
- The mechanism involves the selective suppression of sympathetic neurons in the cutaneous microcirculation.
- These findings support botulinum toxin A as a potential therapeutic agent for improving flap viability in reconstructive surgery.
