Locally injected autologous platelet-rich plasma enhanced tissue perfusion and improved survival of long subdermal plexus skin flaps in dogs

M. Karayannopoulou; L. G. Papazoglou; P. Loukopoulos; G. Kazakos; A. Chantes; N. Giannakas; I. Savvas; D. Psalla; M. Kritsepi-Konstantinou; D. Dionyssiou

doi:10.3415/VCOT-14-02-0030

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2014; 27(05): 379-386
DOI: 10.3415/VCOT-14-02-0030

Original Research

Schattauer GmbH

Locally injected autologous platelet-rich plasma enhanced tissue perfusion and improved survival of long subdermal plexus skin flaps in dogs

M. Karayannopoulou

¹Department of Clinical Studies, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

L. G. Papazoglou

¹Department of Clinical Studies, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

P. Loukopoulos

²Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

G. Kazakos

¹Department of Clinical Studies, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

A. Chantes

³Department of Plastic Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

N. Giannakas

¹Department of Clinical Studies, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

I. Savvas

¹Department of Clinical Studies, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

D. Psalla

²Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

M. Kritsepi-Konstantinou

⁴Department of Clinical Studies, Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

,

D. Dionyssiou

³Department of Plastic Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

› Author Affiliations

Abstract

Summary

Objectives: Distal flap necrosis remains a major complication in subdermal plexus (random) skin flaps. Platelet-rich plasma (PRP) has been shown to improve the survival of ischemic random skin flaps in rats. The objective of this study was to evaluate the effect of locally injected autologous PRP on the survival of long (5:1 length-to-width ratio) subdermal plexus skin flaps in dogs.

Methods: A 2x10 cm subdermal plexus skin flap was created bilaterally on the abdominal wall of six Beagle dogs. One randomly selected side received 2.5 ml of fresh autologous PRP injected evenly between sutures underneath the flap, whereas the other side was left untreated (control). Skin flap survival was evaluated macroscopically, histologically and by laser-Doppler flowmetry measurements of tissue perfusion.

Results: Flap percentage survival on day 10 (96.3% versus 74.5%; p = 0.046) and tissue perfusion (p <0.036) were significantly higher in PRP-treated flaps compared with controls. Histologically, there was less oedema in PRP-treated flaps compared to controls (p = 0.01), whereas collagen production and angiogenesis did not differ significantly between the two groups.

Clinical significance: The use of locally injected autologous PRP increases tissue perfusion and improves the survival of long subdermal plexus skin flaps in dogs.

Keywords

Dog - Laser-Doppler flowmetry - long skin flap survival - platelet-rich plasma - subdermal plexus skin flap

Full Text

References

References
1 Hunt GB. Local or subdermal plexus flaps. In Tobias KM, Johnston SA. editors Veterinary Surgery: Small Animal. St. Louis, Missouri: Elsevier-Saunders; 2012: 1243-1255.
2 Provost PJ, Baily JV. Principles of plastic and reconstructive surgery. In Auer JA, Stick JA. editors Equine Surgery. 4th ed. St.Louis, Missouri: Elsevier-Saunders; 2012: 271-284.
3 Pavletic MM. Atlas of Small Animal Reconstructive Surgery. 2nd ed. Philadelphia: WB Saunders; 1999: 12-19.
4 Wang HJ, Chen TM, Chow LS. et al Recipient bed vascularity and the survival of ischaemic flaps. Br J Plast Surg 1997; 50: 266-271.
5 Zhang F, Waller W, Lineaweaver WC. Growth factors and flap survival. Microsurgery 2004; 24: 162-167.
6 Vourtsis SA, Papalois AE, Agrogiannis GD. et al Improvement of a long random skin flap survival by application of vascular endothelial growth factor in various ways of local administration in a rat model. Indian J Plast Surg 2012; 45: 102-108.
7 Swaim SF. Surgery of traumatized skin: Management and reconstruction in the dog and cat. Philadelphia: WB Saunders Company; 1980: 321-394.
8 Ishiguro N, Yabe Y, Shimizu T. et al Basic fibroblast growth factor has a beneficial effect on the viability of random skin flaps in rats. Ann Plast Surg 1994; 32: 356-360.
9 Kryger Z, Zhang F, Dogan T. et al The effects of VEGF on survival of a random flap in the rat: examination of various routes of administration. Br J Plast Surg 2000; 53: 234-239.
10 Khan A, Ashrafpour H, Huang N. et al Acute local subcutaneous VEGF165 injection for augmentation of skin flap viability: efficacy and mechanism. Am J Physiol Regul Integr Comp Physiol 2004; 287: R1219-1229.
11 Park HJ, Lee S, Kang KH. et al Enhanced random skin flap survival by sustained delivery of fibroblast growth factor 2 in rats. ANZ J Surg 2013; 83: 354-358.
12 Bennett NT, Schultz GS. Growth factors and wound healing: Part II. Role in normal and chronic wound healing. Am J Surg 1993; 166: 74-81.
13 Lawrence WT, Diegelmann RF. Growth factors in wound healing. Clin Dermatol 1994; 12: 157-169.
14 Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004; 114: 1502-1508.
15 Rožman P, Bolta Z. Use of platelet growth factors in treating wounds and soft tissue injuries. Acta Dermatoven APA 2007; 16: 156-165.
16 Alsousou J, Thompson M, Hulley P. et al The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery. J Bone Joint Surg (Br) 2009; 91 B 987-996.
17 Cole BJ, Seroyer ST, Filardo G. et al Platelet-rich plasma: where are we now and where are we going?. Sports Health 2010; 2: 203-210.
18 Souza TFB, Andrade AL, Ferreira TNM. et al Healing and expression of growth factors (TGF-β and PDGF) in canine radial osteotomy gap containing platelet-rich plasma. Vet Comp Orthop Traumatol 2012; 25: 445-452.
19 Silva RF, Carmona JU, Rezende CMF. Intra-articular injections of autologous platelet concentrates in dogs with surgical reparation of cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2013; 26: 285-290.
20 Takikawa M, Sumi Y, Ishihara M. et al PRP & F/P MPs improved survival of dorsal paired pedicle skin flaps in rats. J Surg Res 2011; 170: e189-196.
21 Li W, Enomoto M, Ukegawa M. et al Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg 2012; 129: 858-866.
22 Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004; 62: 489-496.
23 Mehta S, Watson JT. Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma 2008; 22: 433-438.
24 Zhang F, Oswald T, Lin S. et al Vascular endothelial growth factor (VEGF) expression and the effect of exogenous VEGF on survival of a random flap in the rat. Br J Plast Surg 2003; 56: 653-659.
25 Fahie MA, Smith MM. Axial pattern flap based on the cutaneous branch of the superficial temporal artery in dogs: An experimental study and case report. Vet Surg 1999; 28: 141-147.
26 Manning TO, Monteiro-Riviere NA, Bristol DG. et al Cutaneous laser-Doppler velocimetry in nine animal species. Am J Vet Res 1991; 52: 1960-1964.
27 Hölzle F, Loeffelbein DJ, Nolte D. et al Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg 2006; 34: 25-33.
28 Gillette RL, Swaim SF, Sartin EA. et al Effects of a bioactive glass on healing of closed skin wounds in dogs. Am J Vet Res 2001; 62: 1149-1153.
29 Pang Y, Lineaweaver WC, Lei M-P. et al Evaluation of the mechanism of vascular endothelial growth factor improvement of ischemic flap survival in rats. Plast Reconstr Surg 2003; 112: 556-564.
30 Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg 2006; 118: 147-159e.
31 Dionyssiou D, Demiri E, Foroglou P. et al The effectiveness of intralesional injection of platelet-rich plasma in accelerating the healing of chronic ulcers. An experimental and clinical study. Int Wound J 2013; 10: 397-406.
32 Beldon P. Basic science of wound healing. Surgery 2010; 28: 409-412.
33 Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol 2007; 25: 9-18.
34 Hosgood G. Stages of wound healing and their clinical relevance. Vet Clin Small Anim 2006; 36: 667-685.
35 Barrientos S, Stojadinovic O, Golinko MS. et al Growth factors and cytokines in wound healing. Wound Rep Reg 2008; 16: 585-601.
36 Anderson TA, Yu V, Hom DB. et al Interstitial delivery of vascular endothelial growth factor to skin flaps. Arch Facial Plast Surg 2010; 12: 326-331.
37 Knight KR, Collopy PA, O’Brien BMcC. Correlation of viability and laser Doppler flowmetry in ischemic flaps. J Surg Res 1987; 43: 444-451.
38 Kim JT. Utility of laser Doppler flowmetry in postoperative monitoring of free flap. J Korean Soc Plast Reconstr Surg 2002; 29: 302-310.
39 Booi I D, Debats IBJG, Boeckx WD. et al A study of perfusion of the distal free-TRAM flap using laser Doppler flowmetry. J Plast Reconstr Aesthet Surg 2008; 61: 282-288.
40 Ashrafpour H, Huang N, Neligan PC. et al Vasodilator effect and mechanism of action of vascular endothelial growth factor in skin vasculature. Am J Physiol-Heart C 2004; 286: H946-954.