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Bone Marrow Cell Implantation Improves Flap Viability After Ischemia-Reperfusion Injury

Ichioka, Shigeru MD*; Kudo, Satoshi MD*; Shibata, Masahiro PhD; Ando, Joji MD; Sekiya, Naomi MT*; Nakatsuka, Takashi MD*

doi: 10.1097/
Original Article

This study attempted to clarify the effects of therapeutic neovascularization by bone marrow cells for salvaging flaps after ischemia-reperfusion injury. Bone marrow mononuclear cell layer (endothelial progenitor cell-enriched fraction) was isolated from the mouse femur and tibia. Symmetrical double flaps were elevated in mice. Each flap topically received phosphate buffered saline (PBS) or bone marrow cells in PBS. Flaps were subjected to 6-hour ischemia and subsequent reperfusion. On the seventh postoperative day, the flap survival area was measured (n = 27). The mean survival area of bone marrow cells–transplanted flaps was 66.3 ± 18.0%, whereas control flaps showed a survival area of 49.7 ± 22.2%. The difference was highly significant (P = 0.000209). Histologic examination revealed the average vascular density of bone marrow cells–transplanted flaps had significantly increased. The present study proved bone marrow cells acted with significant efficacy in promoting the survival of ischemia-reperfusion-mediated damaged tissue.

In a mouse double dorsal flap model, percutaneous flap injection of bone marrow cells before an ischemia-reperfusion episode resulted in markedly increased flap surviving area and vascular density. It is suggested that the multipotentiality of bone marrow cells permitted differentiation into endothelial cells with growth factor secretion.

From the *Department of Plastic and Reconstructive Surgery, Saitama Medical School, Saitama, Japan; and the †Department of Biomedical Engineering, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Received May 27, 2003 and accepted for publication, after revision, August 20, 2003.

Reprints: Shigeru Ichioka, Department of Plastic and Reconstructive Surgery, Saitama Medical School, 38 Morohongo, Moroyama, Iruma-gun, Saitama, 350–0495, Japan. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.