Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis

Abstract

Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.

Applications of Chitosan and its Derivatives in Skin and Soft Tissue Diseases

“…Skin injuries or necrosis caused by crush, burn, or cut injuries are medical problems warranting urgent care. Common treatment methods include autogenous skin transplantation and free or pedicled skin-flap transplantation, which can cause problems, such as graft tissue necrosis, scar contracture, and poor cosmetic appearance ( Przekora, 2020 ; Li et al, 2021 ). The tissue-repair function of chitosan provides a novel solution for skin reconstruction ( Wei et al, 2022 ).…”

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells Alleviate Ischemia-Reperfusion Injury and Promote Survival of Skin Flaps in Rats

“…However, during preparation and transplantation, tissue flaps inevitably suffer from varying degrees of ischemia-reperfusion (IR) injury, which affects the success of transplantation [ 4 , 5 ]. Despite several efforts, partial necrosis of flaps remains a common clinical problem [ 6 , 7 ].…”

MiR-590-3p affects the function of adipose-derived stem cells (ADSCs) on the survival of skin flaps by targeting VEGFA

“…Boosting flap survival by stem cell therapy has garnered widespread academic interest [ 7 ]. Adipose-derived stem cells (ADSCs), a stem cell population in the adipose tissue, have much differentiation potential [ 8 , 9 ].…”