title: Anti-inflammatory effects of flap and lymph node transfer.
abstract: BACKGROUND
  Transfer of healthy tissue is commonly used in the treatment of complicated wounds and in reconstruction of tissue defects. Recently, microvascular lymph node transfer (LN) has been used to improve the lymphatic function in lymphedema patients. To elucidate the biological effects of flap transfer (with and without lymph nodes), we have studied the postoperative production of proinflammatory, anti-inflammatory, prolymphangiogenic and antilymphangiogenic cytokines, and growth factors (interleukin 1α [IL-1α], IL-1β, tumor necrosis factor α [TNF-α], IL-10, transforming growth factor β1 [TGF-β1], IL-4 and IL-13, and vascular endothelial growth factor C [VEGF-C] and VEGF-D) in postoperative wound exudate samples.
  
  
  METHODS
  Axillary wound exudate samples were analyzed from four patient groups: axillary lymph node dissection (ALND), microvascular breast reconstruction (BR), LN, and combined LN and BR (LN-BR).
  
  
  RESULTS
  The concentration of proinflammatory cytokines was low in all the flap transfer groups as opposed to the ALND group, which showed an extensive proinflammatory response. The level of anti-inflammatory and antifibrotic cytokine IL-10 was increased in the LN-BR group samples compared with the ALND and BR groups. In the LN and LN-BR groups, the cytokine profile showed an anti-inflammatory response.
  
  
  CONCLUSIONS
  Transfer of healthy tissue hinders the proinflammatory response after surgery, which may explain the beneficial effects of flap transfer in various patient groups. In addition, flap transfer with lymph nodes seems to also promote an antifibrotic effect. The clinical effects of LN in lymphedema patients may be mediated by the increased production of prolymphangiogenic growth factor (VEGF-C) and antifibrotic cytokine (IL-10).
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Tiina P
authors.initials: TP
authors.lastname: Viitanen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Mikko T
authors.initials: MT
authors.lastname: Visuri
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Eeva
authors.initials: E
authors.lastname: Sulo
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Saarikko
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland. Electronic address: pauliina.hartiala@tyks.fi.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Hartiala
mesh_terms: D001365:Axilla; D016207:Cytokines / Q000378:metabolism*; D005122:Exudates and Transudates / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000637:transplantation*; D008209:Lymphedema / Q000517:prevention & control; D016462:Mammaplasty; D013524:Surgical Flaps; D042582:Vascular Endothelial Growth Factor C / Q000378:metabolism; D042643:Vascular Endothelial Growth Factor D / Q000378:metabolism; D014947:Wounds and Injuries / Q000378:metabolism*
chemical_list: D016207:Cytokines; D042582:Vascular Endothelial Growth Factor C; D042643:Vascular Endothelial Growth Factor D
keywords: Anti-inflammatory cytokines; IL-10; Lymphatic surgery; Lymphedema; Proinflammatory cytokines