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Background <p>Flap preconditioning enhances tissue vascularization and surgical outcomes by inducing angiogenesis. Vascular endothelial growth factor VEGF is a critical mediator; however, its short half-life limits standalone effectiveness. By incorporating VEGF into fibrin sealants (FS), controlled, localized release is achieved. Therefore, we hypothesized that preoperative administration of VEGF165 combined with fibrin sealant would enhance flap perfusion more effectively than VEGF165 alone.</p> Methods <p>Twenty-four male Sprague-Dawley rats were assigned to four groups (n = 6 each). Control (phosphate-buffered saline), FS alone, VEGF165, and VEGF165 + FS. On Day 0 (T0), a 2 × 10 cm dorsal perforator flap was marked, and the panniculus carnosus was injected according to group assignment. After a 7-day preconditioning period (T7), the flaps, based on the dorsal circumflex iliac artery, were surgically elevated, repositioned, and perfusion was assessed via indocyanine green angiography. A follow-up angiography and tissue biopsy for immunofluorescence analyses were performed 7 days post-surgery (T14).</p> Results <p>At T7, distal perfusion in the VEGF-treated groups was significantly higher than in the Control and FS groups (<i>p</i> &lt; 0.001), with the VEGF + FS group outperforming VEGF alone (<i>p</i> &lt; 0.05). At T14, both VEGF groups maintained superior perfusion compared to non-VEGF groups, and the VEGF + FS group exhibited a greater mature capillary density at the distal choke site (<i>p</i> &lt; 0.05).</p> Conclusions <p>Preoperative administration of VEGF165 with FS enhances distal flap perfusion and vascular maturation more effectively than VEGF165 alone, suggesting a promising strategy to improve perforator flap viability.</p> No Level Assigned <p>This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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The Effect of Controlled Release Mixture of VEGF165 and Fibrin Sealant on Flap Preconditioning in a Rat Perforator Island Flap Model

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Özgün Kılıç,
  • Osman Latifoğlu,
  • Süheyla Esra Özkoçer,
  • Çiğdem Elmas

摘要

Background

Flap preconditioning enhances tissue vascularization and surgical outcomes by inducing angiogenesis. Vascular endothelial growth factor VEGF is a critical mediator; however, its short half-life limits standalone effectiveness. By incorporating VEGF into fibrin sealants (FS), controlled, localized release is achieved. Therefore, we hypothesized that preoperative administration of VEGF165 combined with fibrin sealant would enhance flap perfusion more effectively than VEGF165 alone.

Methods

Twenty-four male Sprague-Dawley rats were assigned to four groups (n = 6 each). Control (phosphate-buffered saline), FS alone, VEGF165, and VEGF165 + FS. On Day 0 (T0), a 2 × 10 cm dorsal perforator flap was marked, and the panniculus carnosus was injected according to group assignment. After a 7-day preconditioning period (T7), the flaps, based on the dorsal circumflex iliac artery, were surgically elevated, repositioned, and perfusion was assessed via indocyanine green angiography. A follow-up angiography and tissue biopsy for immunofluorescence analyses were performed 7 days post-surgery (T14).

Results

At T7, distal perfusion in the VEGF-treated groups was significantly higher than in the Control and FS groups (p < 0.001), with the VEGF + FS group outperforming VEGF alone (p < 0.05). At T14, both VEGF groups maintained superior perfusion compared to non-VEGF groups, and the VEGF + FS group exhibited a greater mature capillary density at the distal choke site (p < 0.05).

Conclusions

Preoperative administration of VEGF165 with FS enhances distal flap perfusion and vascular maturation more effectively than VEGF165 alone, suggesting a promising strategy to improve perforator flap viability.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.