Effects of Vascular Endothelial Growth Factor on Survival of Surgical Flaps: A Review of Experimental Studies

Abstract

Partial or complete necrosis of skin flaps remains a significant problem in plastic and reconstructive surgery. Growth factors have shown promise in improving flap survival through increased angiogenesis and blood supply to the flap. Vascular endothelial growth factor (VEGF) is the most widely investigated and successful one. But the mechanisms of the effects are still not very clear. In the course of a series of experiments, we indicated that tissue survival of surgical flaps could be improved by both preoperative (sustained phase effect) and intraoperative (acute phase effect) application of VEGF. We reviewed both experimental and clinical investigations on the use of VEGF with surgical flaps to summarize the evidence of both phases of VEGF activity in promotion of flaps survival in detail. With the combinations of acute and sustained phases of effects, VEGF protein and gene, VEGF morphologic actions, and VEGF histochemical modulations suggest a pattern of VEGF activity that can be superimposed on classic descriptive mechanisms of tissue survival of flaps.

Effects of diammonium glycyrrhizinate on random skin flap survival in rats: An experimental study

“…VEGF, an angiogenic growth factor, was previously shown to be an effective agent in reducing skin flap necrosis by increasing angiogenesis and blood supply to the skin flap (30,31). In the present study, the expression level of VEGF was higher in the experimental groups than in the control group.…”

Design and Use of Chimeric Proteins Containing a Collagen-Binding Domain for Wound Healing and Bone Regeneration

“…(151, [168][169][170] implantation of a collagen membrane functionalized with CBD-VEGF 1 or injection of this protein 2 in a rat infarcted myocardium  1 better neovascularization of the myocardium  1 reduction of the scar size  1 enhancement of the capillary growth  1 improvement of the cardiac functions  2 CBD-VEGF was almost undetectable in the serum 3 to 6 h post injection, in stark contrast with native VEGF121 CBD-VEGF121 [ TKKTLRT ] (171,172) full-thickness injury uterus 1 (rat), extensive urethral defect 2 (dog)  1 improvement of the pregnancy rate at the scar site (50 vs 19% for VEGF)  2 good regeneration of the urethra (  no VEGF control) VEGF164-CBD [ S3 domain ] (173)(174)(175) subcutaneous injection in a rat dorsal-skin flap model  decrease in the necrosis rate and promotion of the neoangiogenesis  controversial study (concerning the lack of bioactivity of native VEGF)…”

Beneficial effects of Xuebijing injection on random skin flap survival in rats

“…As one of the most widely investigated and successful growth factors, VEGF haas shown promise in improving flap survival through increased angiogenesis and blood supply to the flap [21,22]. In this study, neovascularization and the level of VEGF expression in flaps of test group were significantly higher than those in flaps of control group.…”