We appreciate Dr. Namazi for his interest in our recently published article. Ischemia-reperfusion injury can be the basis of many clinical disorders, including myocardial infarction and stroke. In the field of plastic surgery, it is the major cause of complications that cause cellular and tissue organ injuries during flap surgery. Reperfusion injury has been known to be caused by the accumulation of neutrophils, and some studies have shown that tissue necrosis of the pedicle flap is reduced by blocking the aggregation of neutrophils.1
Other than our research, studies that applied platelet-rich plasma to a flap have recently been reported and explain the mechanism as angiogenesis.2 When we proposed the hypothesis, we assumed that arteriogenesis and angiogenesis, which dilate the choke vessel, were the major mechanisms, but we did not hypothesize that platelet-rich plasma could reduce the reperfusion injury.
We thank Dr. Namazi, who proposed another important mechanism that enabled platelet-rich plasma to reduce flap necrosis. Platelet-rich plasma’s reduction of reperfusion injury had already been experimentally proven through the reduction of the size of myocardial infarction in rabbits.3 Although it had not been proven that platelet-rich plasma reduces reperfusion injury in flap surgery, we believe that the topic is significant enough to be the subject of experiments.
This study was supported by a grant from Kosin University College of Medicine.
The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication.
Hyo Young Kim, M.D.
Jin Hyung Park, M.D., Ph.D.
Yea Sik Han, M.D., Ph.D.
Department of Plastic and Reconstructive Surgery
Kosin University College of Medicine
Busan, Republic of Korea
1. Vedder NB, Winn RK, Rice CL, et al. A monoclonal antibody to the adherence-promoting leukocyte glycoprotein, CD18, reduces organ injury and improves survival from hemorrhagic shock and resuscitation in rabbits. J Clin Invest. 1988;81:939–944
2. 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
3. Hargrave B, Li F. Nanosecond pulse electric field activation of platelet-rich plasma reduces myocardial infarct size and improves left ventricular mechanical function in the rabbit heart. J Extra Corpor Technol. 2012;44:198–204
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