Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

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

Authors’ Contributions

J.A.S.K.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing—original draft, writing—review and editing. A.R.R.H.H.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing. T.G.B.M.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing. I.G.P.H.S.: investigation, methodology, supervision, validation, visualization, writing—review and editing. I.M.D.: investigation, methodology, supervision, validation, visualization, writing—review and editing. I.G.A.S.M.D: investigation, methodology, supervision, validation, visualization, writing—review and editing

Ethical Approval

Ethical clearance for this study was obtained from The Research Ethics Committee of the pertinent institution, with approval number 3135/UN14.2.2.VII.14/LT/2022.

Patient Consent

No patient was involved in this study.

Note

This study was a thesis paper for a residency program in Plastic, Reconstructive and Aesthetic Surgery.

This study was presented at an international meeting, which was the 26th Annual Scientific Meeting of Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons on August 23, 2023, in Manado, North Sulawesi, Indonesia.

Publikationsverlauf

Eingereicht: 21. Oktober 2023

Angenommen: 28. April 2024

Accepted Manuscript online:
30. April 2024

Artikel online veröffentlicht:
13. Juni 2024

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