title: The effect of adipose stromal vascular fraction on transverse rectus abdominis musculocutaneous flap: an experimental study.
abstract: BACKGROUND
  Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the options in reconstruction after breast cancer surgery for breast reconstruction. Tissue necrosis often occurs in the third and fourth perfusion zones of the flap. A study was planned to find out the effects of adipose stromal vascular fraction (SVF) cells on viability of TRAM flap and the experimental model was designed to be applicable in clinical practice.
  
  
  METHODS
  Right inferior epigastric artery pedicled, 5 × 2.5 cm sized TRAM flap was used as a flap model in 30 rats in three groups (group 1: sham; group 2: phosphate-buffered saline (PBS); group 3: SVF cell injected). The viability of the flaps were assessed on the postoperative 7th day with photographs and software for the calculations.
  
  
  RESULTS
  The mean viable flap percentage to total flap area was recorded as 51.8% ± 11.19, 49.5% ± 10.30, 82.3% ± 9.56, in group 1, group 2, and group 3, respectively (p < 0.05). The mean capillary density was noted as 5.15 ± 0.56, 4.37 ± 0.58, and 12.40 ± 1.17 in groups 1, 2, and 3, respectively (p < 0.05). The fibrosis gradient indicated no difference between the groups (p > 0.05). The in-vivo differentiation of SVF cells to endothelial cells was noted. The blood VEGF levels showed a marked increase in the experimental group (p < 0.05).
  
  
  CONCLUSIONS
  The adipose SVF cells were found out to improve the TRAM flap viability and decrease necrosis, especially in zone 3 and 4.
authors.affiliation: a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey ;
authors.forename: Murat Gorkem
authors.initials: MG
authors.lastname: Ataman
authors.affiliation: a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey ;
authors.forename: Cagri A
authors.initials: CA
authors.lastname: Uysal
authors.affiliation: a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey ;
authors.forename: Nilgun Markal
authors.initials: NM
authors.lastname: Ertas
authors.affiliation: b Department of Biochemistry , Baskent University Faculty of Medicine , Ankara , Turkey ;
authors.forename: Nilufer
authors.initials: N
authors.lastname: Bayraktar
authors.affiliation: c Department of Pathology , Baskent University Faculty of Medicine , Ankara , Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Terzi
authors.affiliation: a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey ;
authors.forename: Huseyin
authors.initials: H
authors.lastname: Borman
mesh_terms: D017667:Adipocytes / Q000166:cytology*; D000273:Adipose Tissue / Q000166:cytology*; D000818:Animals; D002478:Cells, Cultured; D042783:Endothelial Cells / Q000166:cytology; D005355:Fibrosis / Q000145:classification; D006085:Graft Survival; D023421:Models, Animal; D064827:Myocutaneous Flap; D018919:Neovascularization, Physiologic; D017207:Rats, Sprague-Dawley; D017568:Rectus Abdominis / Q000637:transplantation*; D017154:Stromal Cells / Q000166:cytology*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D042461:Vascular Endothelial Growth Factor A
keywords: Adipose derived stem cell; musculocutaneous flap; stem cell; stromal vascular fraction; vascular endothelial growth factor; viability