Journal Logo


The Effect of Platelet-Rich Plasma on Flap Survival in Random Extension of an Axial Pattern Flap in Rabbits

Namazi, Hamid M.D.

Author Information
Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 69e
doi: 10.1097/01.prs.0000436527.70708.07
  • Free


I read with great interest the article by Kim et al. This article was published in July of 2013 and concerns the effect of platelet-rich plasma on flap survival.1 The authors nicely showed that platelet-rich plasma can improve flap survival area. I would like to complete the discussion of Kim and colleagues by introducing a major complementary route through which platelet-rich plasma could reduce flap necrosis.

There is a growing body of evidence that a significant portion of flap necrosis is triggered by a sequence of events associated with reperfusion of ischemic tissues, termed “reperfusion injury.”2 The major explanation for reperfusion phenomena is up-regulation of surface adhesion molecules on the vascular endothelium with subsequent adherence and accumulation of polymorphonuclear leukocytes within the vessel lumen. Adherence of polymorphonuclear leukocytes is mediated predominantly by beta-2 integrins (CD11/CD18) on their surface through activation of the NF-kappaB/RANKL pathway.3 Osteoprotegerin, which is a decoy receptor of RANKL, can block the NF-kappaB/RANKL pathway.4

Platelet-rich plasma, which is also called platelet gel, effectively stimulates osteoprotegerin production, leading to significant block of the beta-2 integrin/NFkappaB/RANKL pathway, which subsequently leads to decreased polymorphonuclear leukocyte aggregation and reperfusion injury.5 Therefore, this important mechanism should be borne in mind as the major complementary mechanism for platelet-rich plasma–reduced flap necrosis.


The author has no financial interest to declare in relation to the content of this communication.

Hamid Namazi, M.D.

Department of Orthopedic Surgery

Shiraz University of Medical Sciences

Shiraz, Islamic Republic of Iran

[email protected]


1. Kim HY, Park JH, Han YS, Kim H. The effect of platelet-rich plasma on flap survival in random extension of an axial pattern flap in rabbits. Plast Reconstr Surg. 2013;132:85–92
2. Freitas FA, Piccinato CE, Cherri J, Marchesan WG. Effects of pentoxyfilline and heparin on reperfusion injury island skin flaps in rats exposed to tobacco. J Surg Res. 2010;164:139–145
3. Kim CH, Lee KH, Lee CT, et al. Aggregation of beta2 integrins activates human neutrophils through the IkappaB/NF-kappaB pathway. J Leukoc Biol. 2004;75:286–292
4. Nelson CA, Warren JT, Wang MW, Teitelbaum SL, Fremont DH. RANKL employs distinct binding modes to engage RANK and the osteoprotegerin decoy receptor. Structure. 2012;20:1971–1982
5. Ogino Y, Ayukawa Y, Kukita T, Atsuta I, Koyano K. Platelet-rich plasma suppresses osteoclastogenesis by promoting the secretion of osteoprotegerin. J Periodontal Res. 2009;44:217–224


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2014American Society of Plastic Surgeons