Abstract
Background The risk of flap necrosis in tissue reconstruction surgery is elevated in patients
with vascular disorders, such as diabetes mellitus. Chronic hyperglycemia causes endothelial
cell dysfunction and increases inflammatory process, causing vascular insufficiency.
Platelet-rich plasma (PRP) contains high levels of platelets, growth factors, and
fibrinogens. Its regenerative properties spark interest in supporting flap survival
in relation to diabetic complications.
Methods Thirty Wistar rats were divided into three groups. The first group included diabetic
rats without PRP injection, which underwent flap procedure. The second group included
diabetes-induced rats receiving PRP subcutaneous injection 1 day prior to flap procedure.
The third group included nondiabetic rats receiving PRP injection 1 day prior to flap
procedure. Flap tissue samples were taken on the seventh day to measure vascular endothelial
growth factor (VEGF) levels using enzyme-linked immunosorbent assay method; angiogenesis
and collagen density were measured from histopathology examination, and flap viability
was analyzed using digital measurements.
Results Analysis showed that flap viability, angiogenesis, and VEGF levels were significantly
higher in the PRP-injected diabetic rats compared with diabetic rats that did not
receive PRP. The levels of VEGF, angiogenesis, and viability of flaps in diabetic
rats given PRP did not differ significantly compared with nondiabetic rats that received
PRP.
Conclusion Flap preconditioning through local injection of activated PRP enhances flap viability,
VEGF levels and angiogenesis, in random skin flaps in diabetic rats, to the level
where it does not differ significantly to nondiabetic rats that were given PRP.
Keywords platelet-rich plasma - diabetes mellitus - VEGF - angiogenesis - random skin flap
