BACKGROUND: Advances in the treatment of
reperfusion injury have created an opportunity for
plastic surgeons to apply these treatments to flaps and implanted tissues. The authors examined the direct and indirect effects of adipose-derived
stem cells on ischemia-reperfusion
injury on a
skin flap model to determine the in vivo differentiation of adipose-derived
stem cells to
endothelial cells; the levels of
vascular endothelial growth factor (
VEGF),
transforming growth factor-beta, and
fibroblast growth factor; and the ultrastructural changes apparent with
scanning electron microscopy to clarify the initial events and the following cascades. METHODS: Two identical cranial based
random flaps with a dimension of 1 x 5 cm were elevated on the dorsums of 20
ICR mice. The left flap was designated as the control and the right flap was injected with adipose-derived
stem cells. The flaps were then subjected to 6 hours of
ischemia by clamping the pedicle, and then
reperfusion. RESULTS: The
mean viable flap length in the control and experimental groups was 15.2 +/- 3.4 mm and 24.4 +/- 2.9 mm, respectively. The
mean viable flap area in the control and experimental groups was 12.9 +/- 4.1 mm and 21.8 +/- 3.7 mm, respectively. The in vivo differentiation of adipose-derived
stem cells to
endothelial cells was observed. The
immunohistochemical stainings,
VEGF,
transforming growth factor-beta, and
fibroblast growth factor revealed increased levels in the experimental groups.
Scanning electron microscopy indicated mild
injury in the experimental group. CONCLUSIONS: The adipose-derived
stem cells could prevent ischemia-reperfusion
injury, mainly by regulating the
growth factors. Although
VEGF was the foremost inhibitor of
injury, the overall cascade was enhanced by adipose-derived
stem cells, with the help of the other
growth factors.
