Application study of platelet-rich plasma combined with arterial supercharging technique to enhance survival of ischemic cross-body region skin flaps in rabbits_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Huajian ^1,2 , JIA Mingyu ^1,2 , CHEN Zhihong ^1,2 ,  LIU Yangyang ¹ , ZHANG Kuankuan ¹ , ZHU Zhonglian ¹ , WU Min ¹

1. Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233000, P. R. China;
2. Anhui Provincal Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;

Corresponding?author：

LIU Yangyang, Email: 418825501@qq.com

Keywords：

Platelet-rich plasma; arterial supercharging technique; cross-body region skin flap; angiogenesis; rabbit

DOI：

10.7507/1002-1892.202504080

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effects of combined platelet-rich plasma (PRP) and arterial supercharging technique on the survival rate and functional restoration of cross-body region skin flaps in rabbits. Methods Twelve healthy 6-month-old New Zealand White rabbits were randomly assigned to 4 groups (n=3): sham group, PRP group, anastomosis group, and combined treatment group. An axial skin flap with an area of 12 cm×6 cm on the inner side of the hind limbs of all animals were prepared, with the saphenous artery as the main blood supply. Following the ligation of both the proximal and distal ends of the saphenous artery across all groups, the sham group received no further intervention, the PRP group was subjected to PRP injection, the anastomosis group underwent in situ end-to-end anastomosis of the distal saphenous artery, and the combined treatment group received both in situ distal saphenous artery anastomosis and PRP administration. Flap survival was evaluated and recorded on postoperative days 1, 3, and 7, with survival rates calculated accordingly. On day 7, flap tissue samples were harvested for HE staining to assess basal tissue morphology. Additionally, immunohistochemical staining was conducted to detect the expression of α-smooth muscle actin (α-SMA), vascular endothelial growth factor (VEGF), and CD31 in the flap tissues. Results At postoperative day 1, no significant difference in flap survival rates were observed among the 4 groups (P>0.05). At day 3, the PRP group showed no significant difference compared to the sham group (P>0.05); however, both the anastomosis and combined treatment groups exhibited significantly higher survival rates than the sham group (P<0.05), the combined treatment group further demonstrated superior survival rates compared to both the PRP and anastomosis groups (P<0.05). At day 7, the combined treatment group maintained significantly higher survival rates than all other groups (P<0.05), while both the PRP and anastomosis groups exceeded the sham group (P<0.05). HE staining at day 7 revealed persistent inflammatory cell infiltration, sheet-like erythrocyte deposition, and disordered collagen fibers in the sham group. The PRP group showed nascent microvessel formation and early collagen reorganization, whereas the anastomosis group displayed mature microvasculature with resolved interstitial edema. The combined treatment group exhibited differentiated microvessels with densely packed collagen bundles. Immunohistochemical analysis at day 7 demonstrated significantly larger relative area percentages of α-SMA, VEGF, and CD31 positive cells in the combined treatment group compared to all other groups (P<0.05). Both the PRP and anastomosis groups also showed significantly higher values than the sham group (P<0.05). Conclusion The combination of PRP and arterial supercharging techniques significantly enhances flap healing, potentially through mechanisms involving augmented angiogenesis and improved blood supply.

Citation： ZHOU Huajian, JIA Mingyu, CHEN Zhihong, LIU Yangyang, ZHANG Kuankuan, ZHU Zhonglian, WU Min. Application study of platelet-rich plasma combined with arterial supercharging technique to enhance survival of ischemic cross-body region skin flaps in rabbits. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 873-880. doi: 10.7507/1002-1892.202504080 Copy

1.	張鑫山, 于峻懿, 李贊, 等. 分葉外增壓帶蒂腹直肌肌皮瓣修復巨大胸壁創面的臨床效果. 中華燒傷與創面修復雜志, 2025, 41(3): 251-257.
2.	劉云菡, 黃昕, 李海洲, 等. 擴張的胸廓內動脈穿支皮瓣聯合血管增壓在面頸部瘢痕整復中的臨床應用. 中華燒傷與創面修復雜志, 2022, 38(4): 313-320.
3.	吳云, 李國珍, 曹樹明. 外增壓技術在游離股前外側皮瓣修復下肢軟組織缺損中的臨床療效. 實用手外科雜志, 2018, 32(2): 179-180,192.
4.	郭禮平, 巨積輝, 王凱, 等. 三種外增壓技術改善指背筋膜蒂皮瓣修復效果的臨床比較. 中國美容整形外科雜志, 2021, 32(11): 682-685,703.
5.	何波, 陳文, 馬歲錄, 等. 皮瓣缺血再灌注損傷的發病機制及治療進展. 中國組織工程研究, 2025, 29(6): 1230-1238.
6.	薛文姣. 富血小板纖維蛋白應用于骨外露創面皮瓣轉移的實驗研究. 廈門: 廈門大學, 2018.
7.	Liu Z, Chen DH, Lin ZH, et al. In-situ sprayed platelet-derived small extracellular vesicles for the skin flap survival by reducing PANoptosis. Biomaterials, 2025, 316: 123001. doi: 10.1016/j.biomaterials.2024.123001.
8.	譚強, 吳玲, 劉麗萍, 等. 同種異體富血小板血漿在難愈性創面中的臨床應用. 中國輸血雜志, 2025, 38(5): 734-738.
9.	Aydin O, Karaca G, Pehlivanli F, et al. Platelet-rich plasma may offer a new hope in suppressed wound healing when compared to mesenchymal stem cells. J Clin Med, 2018, 7(6): 143. doi: 10.3390/jcm7060143.
10.	王揚劍. 靜脈超引流與動脈增壓對跨區皮瓣遠端存活的實驗和臨床研究. 蘇州: 蘇州大學, 2021.
11.	李洋, 鄭健生, 王彪, 等. 自體富血小板血漿對游離皮瓣修復兔軟組織缺損的影響. 中華燒傷雜志, 2019, 35(9): 683-689.
12.	唐茂林, 劉元波. 軸型皮瓣與血管體區及穿支體區的內在聯系. 中華整形外科雜志, 2019, 35(9): 8 47-853.
13.	唐茂林, 劉元波. 跨區供血軸型皮瓣的形態學研究進展. 中華整形外科雜志, 2020, 36(9): 961-969.
14.	胡以信, 袁杰, 鄒勇, 等. 富血小板血漿在促進兔燙傷創面愈合中bFGF VEGF的表達及意義. 重慶醫學, 2013, 42(35): 4297-4298, 4301.
15.	高文華, 張宏亮, 胡玉慶, 等. 自體富血小板血漿凝膠聯合皮瓣移植修復對難愈性創面的治療效果. 局解手術學雜志, 2018, 27(2): 88-92.
16.	馬婉茹, 聶志揚, 胡俊華. 富血小板血漿的臨床應用. 臨床輸血與檢驗, 2021, 23(6): 806-811.
17.	蘭杰, 孔來法, 張得意. 富血小板血漿對糖尿病大鼠難愈感染創面的作用機制. 中華醫院感染學雜志, 2023, 33(2): 233-237.
18.	韓峰, 夏正國, 陳慶元, 等. 富血小板血漿凝膠對大鼠分層皮瓣移植效果的影響及機制. 安徽醫學, 2024, 45(10): 1215-1221.
19.	王彥進, 張彬, 陳振雨, 等. PRP對大鼠腹部島狀皮瓣缺血再灌注損傷的影響. 青島大學醫學院學報, 2017, 53(4): 410-412,416.
20.	Shinde AV, Humeres C, Frangogiannis NG. The role of α-smooth muscle actin in fibroblast-mediated matrix contraction and remodeling. Biochim Biophys Acta Mol Basis Dis, 2017, 1863(1): 298-309.
21.	林紹慧, 盛凈, 馬紹駿, 等. CTRP3對TGF-β₁誘導的血管外膜成纖維細胞增殖及α-SMA表達的影響. 上海交通大學學報 (醫學版), 2014, 34(3): 274-278.
22.	王醫術, 李玉林, 王心蕊, 等. 用α-SMA結合部位標記新生血管周細胞. 吉林大學學報 (醫學版), 2003, 29(5): 594-595, 598.
23.	陳倩倩, 唐宋琪, 肖敏. 愈膚散調控CD31、膠原蛋白Ⅲ表達促進慢性皮膚潰瘍創面愈合的作用機制. 時珍國醫國藥, 2023, 34(9): 2063-2066.
24.	徐可佩, 方曉政, 林怡, 等. MRI影像組學與乳腺癌腫瘤新生血管相關性研究. 磁共振成像, 2022, 13(8): 146-149.
25.	Alhusban S, Nofal M, Kovacs-Kasa A, et al. Glucosamine-mediated hexosamine biosynthesis pathway activation uses ATF4 to promote “exercise-like” angiogenesis and perfusion recovery in PAD. Circulation, 2024, 150(21): 1702-1719.
26.	陸世春, 蔣煊, 符德元, 等. 兔VX2肺外周腫瘤超聲造影特征與CD31和CD34微血管密度的相關性研究. 現代生物醫學進展, 2022, 22(20): 3818-3822.

1. 張鑫山, 于峻懿, 李贊, 等. 分葉外增壓帶蒂腹直肌肌皮瓣修復巨大胸壁創面的臨床效果. 中華燒傷與創面修復雜志, 2025, 41(3): 251-257.
2. 劉云菡, 黃昕, 李海洲, 等. 擴張的胸廓內動脈穿支皮瓣聯合血管增壓在面頸部瘢痕整復中的臨床應用. 中華燒傷與創面修復雜志, 2022, 38(4): 313-320.
3. 吳云, 李國珍, 曹樹明. 外增壓技術在游離股前外側皮瓣修復下肢軟組織缺損中的臨床療效. 實用手外科雜志, 2018, 32(2): 179-180,192.
4. 郭禮平, 巨積輝, 王凱, 等. 三種外增壓技術改善指背筋膜蒂皮瓣修復效果的臨床比較. 中國美容整形外科雜志, 2021, 32(11): 682-685,703.
5. 何波, 陳文, 馬歲錄, 等. 皮瓣缺血再灌注損傷的發病機制及治療進展. 中國組織工程研究, 2025, 29(6): 1230-1238.
6. 薛文姣. 富血小板纖維蛋白應用于骨外露創面皮瓣轉移的實驗研究. 廈門: 廈門大學, 2018.
7. Liu Z, Chen DH, Lin ZH, et al. In-situ sprayed platelet-derived small extracellular vesicles for the skin flap survival by reducing PANoptosis. Biomaterials, 2025, 316: 123001. doi: 10.1016/j.biomaterials.2024.123001.
8. 譚強, 吳玲, 劉麗萍, 等. 同種異體富血小板血漿在難愈性創面中的臨床應用. 中國輸血雜志, 2025, 38(5): 734-738.
9. Aydin O, Karaca G, Pehlivanli F, et al. Platelet-rich plasma may offer a new hope in suppressed wound healing when compared to mesenchymal stem cells. J Clin Med, 2018, 7(6): 143. doi: 10.3390/jcm7060143.
10. 王揚劍. 靜脈超引流與動脈增壓對跨區皮瓣遠端存活的實驗和臨床研究. 蘇州: 蘇州大學, 2021.
11. 李洋, 鄭健生, 王彪, 等. 自體富血小板血漿對游離皮瓣修復兔軟組織缺損的影響. 中華燒傷雜志, 2019, 35(9): 683-689.
12. 唐茂林, 劉元波. 軸型皮瓣與血管體區及穿支體區的內在聯系. 中華整形外科雜志, 2019, 35(9): 8 47-853.
13. 唐茂林, 劉元波. 跨區供血軸型皮瓣的形態學研究進展. 中華整形外科雜志, 2020, 36(9): 961-969.
14. 胡以信, 袁杰, 鄒勇, 等. 富血小板血漿在促進兔燙傷創面愈合中bFGF VEGF的表達及意義. 重慶醫學, 2013, 42(35): 4297-4298, 4301.
15. 高文華, 張宏亮, 胡玉慶, 等. 自體富血小板血漿凝膠聯合皮瓣移植修復對難愈性創面的治療效果. 局解手術學雜志, 2018, 27(2): 88-92.
16. 馬婉茹, 聶志揚, 胡俊華. 富血小板血漿的臨床應用. 臨床輸血與檢驗, 2021, 23(6): 806-811.
17. 蘭杰, 孔來法, 張得意. 富血小板血漿對糖尿病大鼠難愈感染創面的作用機制. 中華醫院感染學雜志, 2023, 33(2): 233-237.
18. 韓峰, 夏正國, 陳慶元, 等. 富血小板血漿凝膠對大鼠分層皮瓣移植效果的影響及機制. 安徽醫學, 2024, 45(10): 1215-1221.
19. 王彥進, 張彬, 陳振雨, 等. PRP對大鼠腹部島狀皮瓣缺血再灌注損傷的影響. 青島大學醫學院學報, 2017, 53(4): 410-412,416.
20. Shinde AV, Humeres C, Frangogiannis NG. The role of α-smooth muscle actin in fibroblast-mediated matrix contraction and remodeling. Biochim Biophys Acta Mol Basis Dis, 2017, 1863(1): 298-309.
21. 林紹慧, 盛凈, 馬紹駿, 等. CTRP3對TGF-β₁誘導的血管外膜成纖維細胞增殖及α-SMA表達的影響. 上海交通大學學報 (醫學版), 2014, 34(3): 274-278.
22. 王醫術, 李玉林, 王心蕊, 等. 用α-SMA結合部位標記新生血管周細胞. 吉林大學學報 (醫學版), 2003, 29(5): 594-595, 598.
23. 陳倩倩, 唐宋琪, 肖敏. 愈膚散調控CD31、膠原蛋白Ⅲ表達促進慢性皮膚潰瘍創面愈合的作用機制. 時珍國醫國藥, 2023, 34(9): 2063-2066.
24. 徐可佩, 方曉政, 林怡, 等. MRI影像組學與乳腺癌腫瘤新生血管相關性研究. 磁共振成像, 2022, 13(8): 146-149.
25. Alhusban S, Nofal M, Kovacs-Kasa A, et al. Glucosamine-mediated hexosamine biosynthesis pathway activation uses ATF4 to promote “exercise-like” angiogenesis and perfusion recovery in PAD. Circulation, 2024, 150(21): 1702-1719.
26. 陸世春, 蔣煊, 符德元, 等. 兔VX2肺外周腫瘤超聲造影特征與CD31和CD34微血管密度的相關性研究. 現代生物醫學進展, 2022, 22(20): 3818-3822.

Chinese Journal of Reparative and Reconstructive Surgery

Application study of platelet-rich plasma combined with arterial supercharging technique to enhance survival of ischemic cross-body region skin flaps in rabbits

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content