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Effect of Adipose Stromal Vascular Fraction on Random Pattern Flap Viability in Rats with Diabetes and Chronic Renal Disease: An Experimental Study
Burak Özkan1, Ahmet Cagri Uysal1, Atilla Eyüboglu1, Aysen Terzi2, 3Eda Özturan Özer, 4Hüseyin Borman, 1Nilgün Markal Ertas
1Baskent University Plastic Reconstructive and Aesthetic Surgery, Ankara, 2Baskent University Department of Pathology, Ankara, 3Baskent University Department of Biochemistry, Ankara, HB-Clinic, Ankara, Turkey

INTRODUCTION: Diabetes (DM) and chronic renal disease (CRD) are epidemic diseases with increasing prevalence. Wounds due to microangiopathy and macroangiopathy tend to heal slowly which can lead to severe morbidites such as amputations. High flap failure rates reported in the reconstruction of these wounds. Studies have shown increased flap viability by adipose derived stromal vascular fraction (SVF). However; there is no study in the literature about the effect of adipose stromal vascular fraction on skin flap viability in chronic renal disease and diabetes with chronic renal disease.
METHODS: 48 male Sprague Dawley rats were used. Diabetes was induced by 65mg/kg intraperitoneal streptozocin administiration. Chronic renal disease was induced by 5/6 nephrectomy. Four groups consisting of 12 rats were formed. 2 rats were used for obtaining adipose tissue from the inguinal regions for stromal vascular fraction preparation in each group. Group I (Control group): Two dorsal flaps were elevated, phosphate buffered saline (PBS) were injected to the flaps. Group II (DM), Group III(CRD), Group IV(DM+CRD): After disease induction and period;, two dorsal flaps were elevated, SVF were injected to the left flap, PBS were injected to the right flap. Flaps were harvested for macroscopic and histopathological assesments at postoperative 7th day. Percentage of flap viability measurement and microangiography were performed for macroscopic assesment. Capillary density assesment were evaluated in both hemotoxylin-eosin and CD31 stained specimens for microscopic assesment. Plasma levels of VEGF were studied in all rats at day 1 and day 7.
RESULTS: SVF was improved flap viability significantly (p<0,05). New capillary formation found signficantly more in SVF groups in capillary dansity assesment (p<0,05) .This result was compatible with the scarcity of the vasculature in microangiography. When blood VEGF levels were compared, increase in day 1 and day 7 were significant according to control group (p<0,05). When groups were compared each other there were not significant difference except Group II(diabetes)
DISCUSSION & CONCLUSIONS: The result of the study has shown that DM and CRD impaired flap viability. Diabetes with chronic renal disease detoriated the flap viability much more. It has shown that SVF were increased flap viability via neovascularization by endothelial diffentiation. Flap viability percentage was found lower in diabetic and uremic groups when compared with healthy control group. Blood VEGF levels were not elevated in uremic groups. This results were indicated that in vivo function of stem cells were possibly impared by uremia dominantly and diabetes due to microenviromental changings.


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