Saturday, October 17
INTRODUCTION: Although, the use of free flap in reconstructive surgery has increased over time,1 the complications related to obstructed venous outflow are common in flap transfer and can result in irreversible tissue injury, necrosis, and flap loss.2 Microneedling aims to induce as many microwounds in the dermis by the needle pricks as possible rolling needles vertically, horizontally and diagonally with pressure over the treated area.3 Microneedling initiate the normal phases of wound healing. makes it release of many growth factors and cytokines.4 Platelet rich plasma (PRP) is a rich source of growth factors, has been found effective in accelerating significant tissue repair and regeneration, and releases massive quantities of platelet growth factors.4
The purpose of our study is to determine the efficiency of microneedling and PRP enriched microneedling method for alleviating the harmful effect of venous congestion.
MATERIALS AND METHODS: Ten adult male Wistar rats were used to obtain platelet rich plasma. A bilateral an epigastric skin flap based on the superficial epigastric artery and vein were harvested. The animals were randomized into five groups (n=8 each group): sham, control, microneedling (M), PRP applied microneedling (M+PRP), platelet poor plasma (PPP) applied microneedling group (M+PPP). Four hours of complete ischemia was induced (except in sham group) and after the end of ischemia, treatments were applied. Flap necrosis, neuronal and non-neuronal levels of Substance P as well as histological changes in the tissues were evaluated at the seventh postoperative day.
RESULTS: Surviving flap area of M+PRPgroup was significantly higher (p<0,01) than all the other groups. Microneeding alone increased the survival of the flap area when compared to the control group (Table 1). In M+PRP group, all epidermal layers were clearly organized and dermal integrity was similar to sham dermiş (figure 1). We also observed that microneeding alone markedly decreased Substance P levels (p=0,001)demonstrating activation of sensory nerve fibers. which might br involved in healing process.
CONCLUSION: M+PRP might be an effective treatment modality to reduce congestion, interstitial edema and increase neoangiogenesis in venous congested skin flaps. Our results suggests that growth factors of PRP in addition to M-induced activation of sensory nerve fibers increases tissue survival and regeneration.
1. Lee BT, Matsui A, Hutteman M, Lin SJ, Winer JH, et al. Intraoperative near-infrared fluorescence imaging in perforator flap reconstruction: current research and early clinical experience. Journal of Reconstructive Microsurgery. 2010;26:59–65
2. Nguyen GK, Hwang BH, Zhang Y, Monahan JF, Davis GB, et al. Novel biomarkers of arterial and venous ischemia in microvascular flaps. PLoS One. 2013;8:e71628
3. Fernandes D. Percutaneous collagen induction: an alternative to laser resurfacing. Aesthetic Surg J. 2002;22:315
©2015American Society of Plastic Surgeons
4. Fernandes D, Signorini M. Combating photoaging with percutaneous collagen induction. Clin Dermatol. 2008;26:192–199