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Hyaluronic acid dermal filler injection increases the survival of rat dorsal skin flaps

  • Experimental Study
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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Distal tip necrosis of random pattern skin flaps is the most occurring complication in skin flap surgery. Delay phenomenon augments flap vascularity and increases survival of skin flaps. In this study, hyaluronic acid dermal filler was used in the rat dorsal skin via subcutaneous injection to reveal its role in the flap viability and the delay phenomenon.

Methods

Eighteen rats were randomized in 3 groups. Group 1 rats were the control group. Group 2 rats underwent surgical delay procedure. Group 3 was pretreated with 1 mL of hyaluronic acid dermal filler injection. Seven days after, a caudally based dorsal skin flap was elevated. Flap necrosis area, intensity of the newly formed vessels, subdermal vascular architecture, and inflammation severity in the flaps were evaluated.

Results

Flap necrosis areas were found statistically significant among the groups. The mean number of subdermal capillaries increased significantly in group 3. The mean values of vessel diametres were statistically significant among the groups. Inflammation scores of groups 2 and 3 were low or moderate levels.

Conclusions

HA injection increases the survival of rat dorsal flaps; however, it is not superior or equivalent to surgical delay at least with this volume, concentration, and delay time.

Level of evidence: Not ratable.

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References

  1. Lineaweaver WC, Lei MP, Mustain W, Oswald TM, Cui D, Zhang F (2004) Vascular endothelium growth factor, surgical delay, and skin flap survival. Ann Surg 239(6):866–873

    Article  PubMed  PubMed Central  Google Scholar 

  2. Menevşe GT, TeomanTellioglu A, Altuntas N, Cömert A, Tekdemir I (2014) Polidocanol injection for chemical delay and its effect on the survival of rat dorsal skin flaps. J Plast Reconstr Aesthet Surg 67(6):851–856

    Article  PubMed  Google Scholar 

  3. Doğan F, Özyazgan İ (2015) Flap preconditioning by electrical stimulation as an alternative to surgical delay: experimental study. Ann Plast Surg 75(5):560–564

    Article  PubMed  Google Scholar 

  4. Pang CY, Forrest CR, Morris SF (1989) Pharmacological augmentation of skin flap viability: a hypothesis to mimic the surgical delay phenomenon or a wishful thought. Ann Plast Surg 22:293–306

    Article  CAS  PubMed  Google Scholar 

  5. Hamilton K, Wolfswinkel EM, Weathers WM, Xue AS, Hatef DA, Izaddoost S, Hollier LH Jr (2014) The delay phenomenon: a compilation of knowledge across specialties. Craniomaxillofac Trauma Reconstr 7(2):112–118

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ruppert SM, Hawn TR, Arrigoni A, Wight TN, Bollyky PL (2014) Tissue integrity signals communicated by high-molecular weight hyaluronan and the resolution of inflammation. Immunol Res 58(2–3):186–192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J (2009) Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg 35(Suppl 1):302–312

    Article  CAS  PubMed  Google Scholar 

  8. Fallacara A, Baldini E, Manfredini S, Vertuani S (2018) Hyaluronic acid in the third millennium. Polymers (Basel) 10(7):701

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ponomareva T, Sliadovskii D, Timchenko M, Molchanov M, Timchenko A, Sogorin E (2020) The effect of hepatopancreas homogenate of the Red king crab on HA-based filler. PeerJ 8:e8579

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shalom A, Hadad E, Friedman T, Kremer E, Westreich M (2008) Effect of hyaluronic acid on random-pattern flaps in rats. Dermatol Surg 34(9):1212–1215

    CAS  PubMed  Google Scholar 

  11. Inbal A, Lemelman BT, Millet E, Greensmith A (2017) Tissue expansion using hyaluronic acid filler for single-stage ear reconstruction: a novel concept for difficult areas. Aesthet Surg J 37(10):1085–1097

    Article  PubMed  Google Scholar 

  12. Perng CK, Wang YJ, Tsi CH, Ma H (2011) In vivo angiogenesis effect of porous collagen scaffold with hyaluronic acid oligosaccharides. J Surg Res 168(1):9–15

    Article  CAS  PubMed  Google Scholar 

  13. Khouri RK, Angel MF (1986) Edstrom LE Standardizing the dorsal rat flap. Plast Surg 37:590–591

    Google Scholar 

Download references

Funding

This work was supported by Mersin University Scientific Research and Project Unit with project number 2020–1-TP3-4037.

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Authors and Affiliations

  1. Plastic, Reconstructive and Aesthetic Surgery Department, Mersin University Medical Faculty, Mersin, Turkey

    Nazım Gümüş

  2. Plastic, Reconstructive and Aesthetic Surgery Department, Mersin City Hospital, Mersin, Turkey

    Erkan Pinegöz

  3. Medical Pathology Department, Mersin University Medical Faculty, Mersin, Turkey

    Ferah Tuncel

Authors
  1. Nazım Gümüş
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  2. Erkan Pinegöz
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  3. Ferah Tuncel
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Corresponding author

Correspondence to Nazım Gümüş.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Mersin University (date:10/02/2020, no: 01–02). All institutional and national guidelines for the care and use of laboratory animals were followed. This study was performed in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals.

Informed consent

Not applicable.

Conflict of interest

Nazım Gümüş, Erkan Pinegöz, and Ferah Tuncel declare no competing interests.

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Gümüş, N., Pinegöz, E. & Tuncel, F. Hyaluronic acid dermal filler injection increases the survival of rat dorsal skin flaps. Eur J Plast Surg 46, 181–188 (2023). https://doi.org/10.1007/s00238-022-02004-6

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  • DOI: https://doi.org/10.1007/s00238-022-02004-6

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