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Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
Yuan Li1, Qi-Lin Jiang1, Leanne Van der Merwe2
1Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Nan Bai Xiang, Wenzhou, Zhejiang, 325000, People's Republic of China.
Background:
A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention.
Methods:
This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software.
Results:
Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1).
Conclusions:
The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.
Insights
Stem cell therapy significantly reduces skin flap necrosis by promoting blood vessel growth and upregulating vascular endothelial growth factor (VEGF). This approach shows promise for improving skin flap survival in preclinical models.
Area of Science:
- Regenerative Medicine
- Surgical Innovation
- Biomedical Engineering
Background:
- Skin flap necrosis is a major complication limiting reconstructive surgery.
- Current treatments lack consensus, necessitating novel interventions.
- Stem cell therapy is emerging as a potential solution to enhance skin flap survival.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of stem cell therapy in preventing skin flap necrosis.
- To identify factors influencing the effectiveness of stem cell treatment for skin flaps.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched major databases (Web of Science, EMBASE, PubMed, Cochrane Library) for relevant studies.
- Included 20 studies involving 500 animals, with manual reference checks.
Main Results:
- Stem cell treatment significantly reduced skin flap necrosis (SMD: 3.20).
- Efficacy varied based on skin flap area, cell type, transplant type, and administration method.
- Stem cell therapy increased blood vessel density (SMD: 2.96) and vascular endothelial growth factor (VEGF) expression (SMD: 4.34).
Conclusions:
- Stem cell therapy promotes angiogenesis via VEGF upregulation, improving skin flap survival.
- Intra-arterial injection of adipose-derived stem cells (ASCs) or mesenchymal stem cells (MSCs), including xenogenic human cells, showed greater efficacy.
- Stem cell-based therapy presents a promising strategy to prevent skin flap necrosis.
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