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：

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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.	张鑫山, 于峻懿, 李赞, 等. 分叶外增压带蒂腹直肌肌皮瓣修复巨大胸壁创面的临床效果. 中华烧伤与创面修复杂志, 2025, 41(3): 251-257.
2.	刘云菡, 黄昕, 李海洲, 等. 扩张的胸廓内动脉穿支皮瓣联合血管增压在面颈部瘢痕整复中的临床应用. 中华烧伤与创面修复杂志, 2022, 38(4): 313-320.
3.	吴云, 李国珍, 曹树明. 外增压技术在游离股前外侧皮瓣修复下肢软组织缺损中的临床疗效. 实用手外科杂志, 2018, 32(2): 179-180,192.
4.	郭礼平, 巨积辉, 王凯, 等. 三种外增压技术改善指背筋膜蒂皮瓣修复效果的临床比较. 中国美容整形外科杂志, 2021, 32(11): 682-685,703.
5.	何波, 陈文, 马岁录, 等. 皮瓣缺血再灌注损伤的发病机制及治疗进展. 中国组织工程研究, 2025, 29(6): 1230-1238.
6.	薛文姣. 富血小板纤维蛋白应用于骨外露创面皮瓣转移的实验研究. 厦门: 厦门大学, 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.	谭强, 吴玲, 刘丽萍, 等. 同种异体富血小板血浆在难愈性创面中的临床应用. 中国输血杂志, 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.	王扬剑. 静脉超引流与动脉增压对跨区皮瓣远端存活的实验和临床研究. 苏州: 苏州大学, 2021.
11.	李洋, 郑健生, 王彪, 等. 自体富血小板血浆对游离皮瓣修复兔软组织缺损的影响. 中华烧伤杂志, 2019, 35(9): 683-689.
12.	唐茂林, 刘元波. 轴型皮瓣与血管体区及穿支体区的内在联系. 中华整形外科杂志, 2019, 35(9): 8 47-853.
13.	唐茂林, 刘元波. 跨区供血轴型皮瓣的形态学研究进展. 中华整形外科杂志, 2020, 36(9): 961-969.
14.	胡以信, 袁杰, 邹勇, 等. 富血小板血浆在促进兔烫伤创面愈合中bFGF VEGF的表达及意义. 重庆医学, 2013, 42(35): 4297-4298, 4301.
15.	高文华, 张宏亮, 胡玉庆, 等. 自体富血小板血浆凝胶联合皮瓣移植修复对难愈性创面的治疗效果. 局解手术学杂志, 2018, 27(2): 88-92.
16.	马婉茹, 聂志扬, 胡俊华. 富血小板血浆的临床应用. 临床输血与检验, 2021, 23(6): 806-811.
17.	兰杰, 孔来法, 张得意. 富血小板血浆对糖尿病大鼠难愈感染创面的作用机制. 中华医院感染学杂志, 2023, 33(2): 233-237.
18.	韩峰, 夏正国, 陈庆元, 等. 富血小板血浆凝胶对大鼠分层皮瓣移植效果的影响及机制. 安徽医学, 2024, 45(10): 1215-1221.
19.	王彦进, 张彬, 陈振雨, 等. PRP对大鼠腹部岛状皮瓣缺血再灌注损伤的影响. 青岛大学医学院学报, 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.	林绍慧, 盛净, 马绍骏, 等. CTRP3对TGF-β₁诱导的血管外膜成纤维细胞增殖及α-SMA表达的影响. 上海交通大学学报 (医学版), 2014, 34(3): 274-278.
22.	王医术, 李玉林, 王心蕊, 等. 用α-SMA结合部位标记新生血管周细胞. 吉林大学学报 (医学版), 2003, 29(5): 594-595, 598.
23.	陈倩倩, 唐宋琪, 肖敏. 愈肤散调控CD31、胶原蛋白Ⅲ表达促进慢性皮肤溃疡创面愈合的作用机制. 时珍国医国药, 2023, 34(9): 2063-2066.
24.	徐可佩, 方晓政, 林怡, 等. MRI影像组学与乳腺癌肿瘤新生血管相关性研究. 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.	陆世春, 蒋煊, 符德元, 等. 兔VX2肺外周肿瘤超声造影特征与CD31和CD34微血管密度的相关性研究. 现代生物医学进展, 2022, 22(20): 3818-3822.

1. 张鑫山, 于峻懿, 李赞, 等. 分叶外增压带蒂腹直肌肌皮瓣修复巨大胸壁创面的临床效果. 中华烧伤与创面修复杂志, 2025, 41(3): 251-257.
2. 刘云菡, 黄昕, 李海洲, 等. 扩张的胸廓内动脉穿支皮瓣联合血管增压在面颈部瘢痕整复中的临床应用. 中华烧伤与创面修复杂志, 2022, 38(4): 313-320.
3. 吴云, 李国珍, 曹树明. 外增压技术在游离股前外侧皮瓣修复下肢软组织缺损中的临床疗效. 实用手外科杂志, 2018, 32(2): 179-180,192.
4. 郭礼平, 巨积辉, 王凯, 等. 三种外增压技术改善指背筋膜蒂皮瓣修复效果的临床比较. 中国美容整形外科杂志, 2021, 32(11): 682-685,703.
5. 何波, 陈文, 马岁录, 等. 皮瓣缺血再灌注损伤的发病机制及治疗进展. 中国组织工程研究, 2025, 29(6): 1230-1238.
6. 薛文姣. 富血小板纤维蛋白应用于骨外露创面皮瓣转移的实验研究. 厦门: 厦门大学, 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. 谭强, 吴玲, 刘丽萍, 等. 同种异体富血小板血浆在难愈性创面中的临床应用. 中国输血杂志, 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. 王扬剑. 静脉超引流与动脉增压对跨区皮瓣远端存活的实验和临床研究. 苏州: 苏州大学, 2021.
11. 李洋, 郑健生, 王彪, 等. 自体富血小板血浆对游离皮瓣修复兔软组织缺损的影响. 中华烧伤杂志, 2019, 35(9): 683-689.
12. 唐茂林, 刘元波. 轴型皮瓣与血管体区及穿支体区的内在联系. 中华整形外科杂志, 2019, 35(9): 8 47-853.
13. 唐茂林, 刘元波. 跨区供血轴型皮瓣的形态学研究进展. 中华整形外科杂志, 2020, 36(9): 961-969.
14. 胡以信, 袁杰, 邹勇, 等. 富血小板血浆在促进兔烫伤创面愈合中bFGF VEGF的表达及意义. 重庆医学, 2013, 42(35): 4297-4298, 4301.
15. 高文华, 张宏亮, 胡玉庆, 等. 自体富血小板血浆凝胶联合皮瓣移植修复对难愈性创面的治疗效果. 局解手术学杂志, 2018, 27(2): 88-92.
16. 马婉茹, 聂志扬, 胡俊华. 富血小板血浆的临床应用. 临床输血与检验, 2021, 23(6): 806-811.
17. 兰杰, 孔来法, 张得意. 富血小板血浆对糖尿病大鼠难愈感染创面的作用机制. 中华医院感染学杂志, 2023, 33(2): 233-237.
18. 韩峰, 夏正国, 陈庆元, 等. 富血小板血浆凝胶对大鼠分层皮瓣移植效果的影响及机制. 安徽医学, 2024, 45(10): 1215-1221.
19. 王彦进, 张彬, 陈振雨, 等. PRP对大鼠腹部岛状皮瓣缺血再灌注损伤的影响. 青岛大学医学院学报, 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. 林绍慧, 盛净, 马绍骏, 等. CTRP3对TGF-β₁诱导的血管外膜成纤维细胞增殖及α-SMA表达的影响. 上海交通大学学报 (医学版), 2014, 34(3): 274-278.
22. 王医术, 李玉林, 王心蕊, 等. 用α-SMA结合部位标记新生血管周细胞. 吉林大学学报 (医学版), 2003, 29(5): 594-595, 598.
23. 陈倩倩, 唐宋琪, 肖敏. 愈肤散调控CD31、胶原蛋白Ⅲ表达促进慢性皮肤溃疡创面愈合的作用机制. 时珍国医国药, 2023, 34(9): 2063-2066.
24. 徐可佩, 方晓政, 林怡, 等. MRI影像组学与乳腺癌肿瘤新生血管相关性研究. 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. 陆世春, 蒋煊, 符德元, 等. 兔VX2肺外周肿瘤超声造影特征与CD31和CD34微血管密度的相关性研究. 现代生物医学进展, 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

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