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Local shockwave-induced capillary recruitment improves survival of musculocutaneous flaps.
- Source :
-
The Journal of surgical research [J Surg Res] 2013 Oct; Vol. 184 (2), pp. 1196-204. Date of Electronic Publication: 2013 Apr 02. - Publication Year :
- 2013
-
Abstract
- Background: Shockwave (SW) application has been shown to limit flap necrosis. However, the underlying microhemodynamic mechanisms remain unclear. Therefore, the objective of this study was to analyze the effect of SW application on a microcirculatory level.<br />Methods: We treated 12 C57BL/6 mice with local SW application (500 shockwave impulses at 0.15 mJ/mm(2)) either 24 h before (preconditioning [PRE]) or 30 min after (postconditioning [POST]) flap elevation. Animals with an untreated flap (CON) or without a flap served as controls. We applied dorsal skinfold chambers to the animals and performed epifluorescence microscopy over a 10-d period to assess microcirculatory parameters (arteriolar diameter, red blood cell velocity, blood flow, functional capillary density, and intercapillary distance) as well as inflammation, apoptotic cell death, and necrosis.<br />Results: SW application significantly decreased tissue necrosis independently of the application time point (PRE: 29% ± 7%; POST: 25% ± 7% versus CON: 47% ± 2%; day 10, P < 0.05). Arteriolar diameter, red blood cell velocity, and blood flow were not statistically significantly different among the 3 flap groups. However, SW (PRE and POST) resulted in an early and persistent increase in functional capillary density and consequently decreased intercapillary distance compared with CON and the group without a flap (P < 0.05). Also, SW resulted in a significantly decreased inflammatory response (P < 0.05) and induced an angiogenic response, as indicated by new functional microvessel formation observed 5 d after therapy.<br />Conclusions: Local SW application improved tissue survival by recruitment of sleeping capillaries within the non ischemic tissue and maintenance of capillary perfusion within the critically perfused tissue after induction of ischemia, which was independent of the application time point. Neoangiogenesis occurred beyond the ischemic tolerance of the tissue, and therefore does not seem to contribute to improved tissue survival.<br /> (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Subjects :
- Animals
Dermatologic Surgical Procedures
Mice
Mice, Inbred C57BL
Microcirculation physiology
Models, Animal
Necrosis
Regional Blood Flow physiology
Skin pathology
Capillaries physiology
High-Energy Shock Waves therapeutic use
Neovascularization, Physiologic physiology
Skin blood supply
Surgical Flaps blood supply
Subjects
Details
- Language :
- English
- ISSN :
- 1095-8673
- Volume :
- 184
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of surgical research
- Publication Type :
- Academic Journal
- Accession number :
- 23582757
- Full Text :
- https://doi.org/10.1016/j.jss.2013.03.040