Aesthetic Plastic Surgery

, Volume 37, Issue 1, pp 159–170 | Cite as

Hypoxia Preconditioning Enhances the Viability of ADSCs to Increase the Survival Rate of Ischemic Skin Flaps in Rats

  • Yeli Yue
  • Peipei Zhang
  • Dan Liu
  • Jenny F. Yang
  • Chunlei Nie
  • Daping Yang
Original Article Experimental/Special Topics


Use of a skin flap has been a common technique in reconstructive surgery for more than five decades. However, partial necrosis of its distal end is still a serious postoperative complication. Many theories about this problem have been proposed, including deficient blood supply, which is the most accepted theory. In this study we demonstrated that hypoxic preconditioning enhanced the viability of adipose-derived stem cells (ADSCs) in vivo and improved their ability to increase the survival rate of ischemic skin flaps in rats. Seven days after flap elevation, the flap survival rate in the hypoxic preconditioned ADSC group was higher than that in the control group. Moreover, histological examination showed that more ADSCs survived in flaps treated by hypoxic preconditioning. Vascular density in the hypoxic preconditioned ADSC group was 30–90 % greater than that in the control group. In addition, the expressions of vascular endothelial growth factor and hypoxia inducible factor-1α (HIF-1α) were higher in the hypoxic preconditioned ADSC group than in the control group (p < 0.05). This enhancive phenomenon reached its highest level at the precondition times of 3 and 7 days in the hypoxic preconditioned ADSC group. We conclude that hypoxia preconditioning effectively enhances the viability of ADSCs to increase the survival rate of ischemic skin flaps. Furthermore, 3 days is the optimal preconditioning time point.

Level of Evidence II

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ADSC Hypoxia HIF-1α VEGF Skin flap survival 



This research project was supported by National Natural Science Foundation of China Grants 81171825

Conflicts of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2012

Authors and Affiliations

  • Yeli Yue
    • 1
  • Peipei Zhang
    • 1
  • Dan Liu
    • 1
  • Jenny F. Yang
    • 1
  • Chunlei Nie
    • 2
  • Daping Yang
    • 1
  1. 1.Department of Plastic SurgeryThe Second Hospital of Harbin Medical UniversityHarbinChina
  2. 2.Department of Head and Neck SurgeryThe Third Affiliated Hospital of Harbin Medical UniversityHarbinChina

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