Local shockwave-induced capillary recruitment improves survival of musculocutaneous flaps.

Tobalem, M; Wettstein, R; Pittet-Cuénod, B; Vigato, E; Machens, HG; Lohmeyer, JA; Rezaeian, F; Harder, Y

doi:10.1016/j.jss.2013.03.040

journal article

Titel:: Local shockwave-induced capillary recruitment improves survival of musculocutaneous flaps.
Dokumenttyp:: Journal Article; Research Support, Non-U.S. Gov't
Autor(en):: Tobalem, M; Wettstein, R; Pittet-Cuénod, B; Vigato, E; Machens, HG; Lohmeyer, JA; Rezaeian, F; Harder, Y
Abstract:: 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.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.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.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.
Zeitschriftentitel:: J Surg Res
Jahr:: 2013
Band / Volume:: 184
Heft / Issue:: 2
Seitenangaben Beitrag:: 1196-204
Sprache:: eng
Volltext / DOI:: doi:10.1016/j.jss.2013.03.040
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/23582757
Print-ISSN:: 0022-4804
TUM Einrichtung:: Lehrstuhl für Plastische Chirurgie und Handchirurgie (Prof. Machens)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie (Prof. Machens)Lehrstuhl für Plastische Chirurgie und Handchirurgie (Prof. Machens)2013