Open Access
CC BY 4.0 · Arch Plast Surg 2024; 51(04): 432-440
DOI: 10.1055/a-2317-4520
Research/Experimental
Original Article

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Jenisa Amanda Sandiarini Kamayana 
1   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Udayana University, Bali, Indonesia
,
Agus Roy Rusly Hariantana Hamid 
1   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Udayana University, Bali, Indonesia
,
Tjokorda Gde Bagus Mahadewa 
2   Department of Neurosurgery, Udayana University, Bali, Indonesia
,
I. Gusti Putu Hendra Sanjaya 
1   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Udayana University, Bali, Indonesia
,
I. Made Darmajaya 
3   Division of Paediatric Surgery, Department of Surgery, Udayana University, Bali, Indonesia
,
I. Gusti Ayu Sri Mahendra Dewi 
4   Department of Anatomical Pathology, Udayana University, Bali, Indonesia
› Author Affiliations
Funding None.
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Abstract

Background The risk of flap necrosis in tissue reconstruction surgery is elevated in patients with vascular disorders, such as diabetes mellitus. Chronic hyperglycemia causes endothelial cell dysfunction and increases inflammatory process, causing vascular insufficiency. Platelet-rich plasma (PRP) contains high levels of platelets, growth factors, and fibrinogens. Its regenerative properties spark interest in supporting flap survival in relation to diabetic complications.

Methods Thirty Wistar rats were divided into three groups. The first group included diabetic rats without PRP injection, which underwent flap procedure. The second group included diabetes-induced rats receiving PRP subcutaneous injection 1 day prior to flap procedure. The third group included nondiabetic rats receiving PRP injection 1 day prior to flap procedure. Flap tissue samples were taken on the seventh day to measure vascular endothelial growth factor (VEGF) levels using enzyme-linked immunosorbent assay method; angiogenesis and collagen density were measured from histopathology examination, and flap viability was analyzed using digital measurements.

Results Analysis showed that flap viability, angiogenesis, and VEGF levels were significantly higher in the PRP-injected diabetic rats compared with diabetic rats that did not receive PRP. The levels of VEGF, angiogenesis, and viability of flaps in diabetic rats given PRP did not differ significantly compared with nondiabetic rats that received PRP.

Conclusion Flap preconditioning through local injection of activated PRP enhances flap viability, VEGF levels and angiogenesis, in random skin flaps in diabetic rats, to the level where it does not differ significantly to nondiabetic rats that were given PRP.

Keywords

platelet-rich plasma - diabetes mellitus - VEGF - angiogenesis - random skin flap

Authors’ Contributions

J.A.S.K.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing—original draft, writing—review and editing. A.R.R.H.H.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing. T.G.B.M.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing. I.G.P.H.S.: investigation, methodology, supervision, validation, visualization, writing—review and editing. I.M.D.: investigation, methodology, supervision, validation, visualization, writing—review and editing. I.G.A.S.M.D: investigation, methodology, supervision, validation, visualization, writing—review and editing


Ethical Approval

Ethical clearance for this study was obtained from The Research Ethics Committee of the pertinent institution, with approval number 3135/UN14.2.2.VII.14/LT/2022.


Patient Consent

No patient was involved in this study.


Note

This study was a thesis paper for a residency program in Plastic, Reconstructive and Aesthetic Surgery.


This study was presented at an international meeting, which was the 26th Annual Scientific Meeting of Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons on August 23, 2023, in Manado, North Sulawesi, Indonesia.




Publication History

Received: 21 October 2023

Accepted: 28 April 2024

Accepted Manuscript online:
30 April 2024

Article published online:
13 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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