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Published on: January 27, 2023
The Effect of Controlled Release Mixture of VEGF165 and Fibrin Sealant on Flap Preconditioning in a Rat Perforator
Özgün Kılıç1, Osman Latifoğlu2, Süheyla Esra Özkoçer3
1Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara Etlik City Hospital, 06170, Ankara, Turkey. ozgunkilic@outlook.com.
Background:
Flap preconditioning enhances tissue vascularization and surgical outcomes by inducing angiogenesis. Vascular endothelial growth factor VEGF is a critical mediator; however, its short half-life limits standalone effectiveness. By incorporating VEGF into fibrin sealants (FS), controlled, localized release is achieved. Therefore, we hypothesized that preoperative administration of VEGF165 combined with fibrin sealant would enhance flap perfusion more effectively than VEGF165 alone.
Methods:
Twenty-four male Sprague-Dawley rats were assigned to four groups (n = 6 each). Control (phosphate-buffered saline), FS alone, VEGF165, and VEGF165 + FS. On Day 0 (T0), a 2 × 10 cm dorsal perforator flap was marked, and the panniculus carnosus was injected according to group assignment. After a 7-day preconditioning period (T7), the flaps, based on the dorsal circumflex iliac artery, were surgically elevated, repositioned, and perfusion was assessed via indocyanine green angiography. A follow-up angiography and tissue biopsy for immunofluorescence analyses were performed 7 days post-surgery (T14).
Results:
At T7, distal perfusion in the VEGF-treated groups was significantly higher than in the Control and FS groups (p < 0.001), with the VEGF + FS group outperforming VEGF alone (p < 0.05). At T14, both VEGF groups maintained superior perfusion compared to non-VEGF groups, and the VEGF + FS group exhibited a greater mature capillary density at the distal choke site (p < 0.05).
Conclusions:
Preoperative administration of VEGF165 with FS enhances distal flap perfusion and vascular maturation more effectively than VEGF165 alone, suggesting a promising strategy to improve perforator flap viability.
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