Accelerated flap prefabrication with vascular endothelial growth factor

Vascular endothelial growth factor (VEGF) is a potent promoter of angiogene sis that has been shown to enhance revascularization of ischemic tissues, i ncluding skin flaps. This study was designed to investigate the value of a single topical application of recombinant human VEGF to accelerate flap via bility in a rat model of a non-ischemic prefabricated flap. Prefabricated f laps were created in 48 Sprague-Dawley rats. An autologous tail artery loop was anastomosed to the femoral artery and vein, and implanted subcutaneous ly in the lower abdomen. Flaps were divided into two groups of 24 each. At the time of loop implantation, the control group received 0.9 percent NaCl or a 16 percent vol/wet polyvinyl alcohol (PVA) solution; the treatment gro up received VEGF in 0.9 percent NaCl or VEGF in PVA. The PVA gel was used t o facilitate topical application. In each group, 3- X 4-cm flaps nurtured b y the tail artery pedicle were elevated and resutured into place after 3, 4 , and 5 weeks. The percentage of surviving skin of each flap was determined by planimetry 7 days after flap elevation. Mean skin survival areas at 3, 4, and 5 weeks were: control group, 0 percent, 8 percent, and 17.5 percent; and VEGF-treated group, 6 percent, 40 percent, and 66.7 percent, respectiv ely. VEGF significantly improved flap survival by 5 weeks (p = 0.02). These results suggest that VEGF can accelerate maturation of prefabricated flaps . This approach could expand the application of flap prefabrication as a re source for reconstructive surgery.