title: Adipose derived stem cells protect skin flaps against ischemia-reperfusion injury.
abstract: BACKGROUND
  Advances in the treatment of ischemia- reperfusion injury have created an opportunity for plastic surgeons to apply these treatments to flaps and implanted tissues. We examined the capability of adipose derived stem cells (ADSCs) to protect tissue against IRI using an extended inferior epigastric artery skin flap as a flap ischemia- reperfusion injury (IRI) model.
  
  
  METHODS
  ADSCs were isolated from Lewis rats and cultured in vitro. Twenty- four rats were randomly divided into three groups. Group I was the sham group and did not undergo ischemic insult; rather, the flap was raised and immediately sutured back (non-ischemic control group). Group II (ischemia control) and group III (ADSCs treatment) underwent 3 h of ischemic insult. During reperfusion group III was treated by intravenous application of ADSCs and group II was left untreated. Five days postoperatively, flap survival and perfusion were assessed. Microvessel density was visualized by immunohistochemistry and semi- quantitative real-time polymerase chain reaction addressed differential gene expression.
  
  
  RESULTS
  Treatment with ADSCs significantly increased flap survival (p<0.001) and flap perfusion (p<0.001) when compared to the control group II. Microvessel- density in ADSCs treated group was not significantly increased in any group. No significant differences showed the comparison of the experimental group III and the sham operated control group I. ADSCs treatment (Group III) was accompanied by a significantly enhanced expression of pro-angiogenic and pro-inflammatory genes.
  
  
  CONCLUSIONS
  Overall, our study demonstrates that ADSCs treatment significantly enhances skin flap survival in the aftermath of ischemia to an extent that almost equals surgical results without ischemia. This effect is accompanied with a pronounced and significant angiogenic response and an improved blood perfusion.
authors.affiliation: ETHIANUM - Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Vossstr. 6, 69115 Heidelberg, Germany. am.reichenberger@t-online.de
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Reichenberger
authors.forename: Sina
authors.initials: S
authors.lastname: Heimer
authors.forename: Amelia
authors.initials: A
authors.lastname: Schaefer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lass
authors.forename: Martha Maria
authors.initials: MM
authors.lastname: Gebhard
authors.forename: Günter
authors.initials: G
authors.lastname: Germann
authors.forename: Uwe
authors.initials: U
authors.lastname: Leimer
authors.forename: Eva
authors.initials: E
authors.lastname: Köllensperger
authors.forename: Wolf
authors.initials: W
authors.lastname: Mueller
mesh_terms: D050153:Abdominal Fat / Q000473:pathology*; D050156:Adipogenesis; D042501:Angiogenic Proteins / Q000235:genetics / Q000378:metabolism; D000818:Animals; D015703:Antigens, CD / Q000378:metabolism; D049109:Cell Proliferation; D058948:Cell Tracking; D002478:Cells, Cultured; D019074:Epigastric Arteries / Q000378:metabolism / Q000473:pathology; D005337:Fibrin / Q000737:chemistry*; D015870:Gene Expression; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D055806:Microvessels / Q000473:pathology; D010641:Phenotype; D051381:Rats; D011917:Rats, Inbred Lew; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000502:physiology*; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology*; D054457:Tissue Scaffolds / Q000737:chemistry
chemical_list: D042501:Angiogenic Proteins; D015703:Antigens, CD; D018836:Inflammation Mediators; D005337:Fibrin