Effects of Insulin-Dependent Diabetes Mellitus on Perforator-Based Flaps in Streptozotocin Diabetic Rats

ABSTRACT

The purpose of this study was to investigate the effects of insulin-dependent diabetes mellitus (IDDM) on the viability of perforator-based flaps (pbf) in diabetic rats. Random-pattern flaps were also used as a control flap group. Wistar Albino rats, female, n = 60, were used. The study was done with four groups: Group 1 (diabetic rats, pbf), Group 2 (non-diabetic rats, pbf), Group 3 (diabetic rats, McFarlane flap), and Group 4 (non-diabetic rats, McFarlane flap). Streptozocin (STZ, 55 mg/kg) in a vehicle (sodium citrate, pH 4.5) was injected into the rats intraperitonally to create an IDDM model in the diabetic groups. Only the vehicle without STZ was injected into the rats intraperitonally in the non-diabetic groups. All flaps were elevated 10 weeks after injections. Measurements of the surviving areas of the flaps, and microangiographic and histopathologic studies were done 7 days after flap elevation. Blood glucose levels of the diabetic rats were significantly higher than those of the non-diabetic groups (p < 0.001). The surviving flap areas were 41 ± 21 percent in Group 1, 65 ± 25 percent in Group 2, 49 ± 10 percent in Group 3, and 66 ± 10 percent in Group 4. The surviving flap areas of the diabetic groups were significantly less than those of the non-diabetic groups (p < 0.001). Specific histopathologic changes of IDDM were seen only in the diabetic groups. Microangiographies in the diabetic and non-diabetic groups were very similar. The surviving flap areas of the perforator-based and random-pattern skin flaps in the diabetic rats were decreased by IDDM. If a flap is planned for diabetic wounds, it should be kept in mind that the area of flap necrosis may be larger than those of non-diabetics.

KEYWORDS

Diabetes - flap - necrosis

REFERENCES

• 1 Vinik A I, Vinik E. Prevention of the complications of diabetes.  Am J Manag Care. 2003;  9 63-80
• 2 Greenwald D-P, Shumway S, Zachary L-S et al.. Endogenous versus toxin-induced diabetes in rats: a mechanical comparison of two skin wound healing models.  Plast Reconstr Surg. 1993;  91 1087-1093
• 3 Yue D-K, McLennan S, Marsh M et al.. Effects of experimental diabetes, uremia, and malnutrition on wound healing.  Diabetes. 1987;  36 295-299
• 4 Fahey III T J, Sadaty A, Jones II W G et al.. Diabetes impairs the late inflammatory response to wound healing.  J Surg Res. 1991;  50 308-313
• 5 Bitar M S, Labbad Z N. Transforming growth factor-beta and insulin-like growth factor-I in relation to diabetes-induced impairment of wound healing.  J Surg Res. 1996;  15 113-119
• 6 Seifter E, Rettura G, Padawer J et al.. Impaired wound healing in streptozotocin diabetes. Prevention by supplemental vitamin A.  Ann Surg. 1981;  194 42-50
• 7 Oksar H S, Coskunfirat O K, Ozgentas H E. Perforator-based flap in rats: a new experimental model.  Plast Reconstr Surg. 2001;  108 125-131
• 8 Coskunfirat O K, Oksar H S, Ozgentas H E. Effect of the delay phenomenon in the rat single-perforator-based abdominal skin flap model.  Ann Plast Surg. 2000;  45 42-47
• 9 Dunn R M, Mancoll J. Flap models in the rat: a review and reappraisal.  Plast Reconstr Surg. 1992;  90 319-328
• 10 Hammond D C, Brooksher R D, Mann R J et al.. The dorsal skin-flap model in the rat: factors influencing survival.  Plast Reconstr Surg. 1993;  91 316-321
• 11 Cuono C B, Marquetand R, Klein M B. Critical role of phosphagens in the energy cascade of cutaneous ischemia and protective action of phosphocreatine analogues in skin flap survival.  Plast Reconstr Surg. 1998;  101 1597-1603
• 12 Aker J S, Mancoll J, Lewis B et al.. The effect of pentoxyfilline on random-pattern skin flap necrosis induced by nicotine treatment in the rat.  Plast Reconstr Surg. 1997;  100 66-71
• 13 Yang D, Morris S F. Comparison of two different delay procedures in a rat skin flap model.  Plast Reconstr Surg. 1998;  102 1591-1597
• 14 Babovic S, Shin M S, Angel M F et al.. Flap tolerance to ischaemia in streptozotocin-induced diabetes mellitus.  Br J Plast Surg. 1994;  47 15-19
• 15 Weinzweig N, Davies B W. Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.  Plast Reconstr Surg. 1998;  102 1999-2005
• 16 Guyuron B, Raszewski R. Undetected diabetes and the plastic surgeon.  Plast Reconstr Surg. 1990;  86 471-474
• 17 Atiyeh B S, Sfeir R E, Hussein M M. Preliminary arteriovenous fistula for free-flap reconstruction in the diabetic foot.  Plast Reconstr Surg. 1995;  95 1062-1069
• 18 Lilienfeld D E, Vlahov D, Tenney J H et al.. Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery.  Am J Infect Control. 1998;  16 3-6
• 19 Logerfo F W, Gibbons G W. Vascular disease of the lower extremities in diabetes mellitus.  Endocrinol Metabol Clin North Am. 1996;  25 439-435
• 20 Bitar M S. Glucocorticoid dynamics and impaired wound healing in diabetes mellitus.  Am J Pathol. 1998;  152 547-554
• 21 Rendell M S, Kelly S T, Finney D et al.. Decreased skin blood flow early in the course of streptozotocin-induced diabetes mellitus in the rat.  Diabetologia. 1993;  36 907-911
• 22 Colen L B, Stevenson A, Sidorov V et al.. Microvascular anastomotic thrombosis in experimental diabetes mellitus.  Plast Reconstr Surg. 1997;  99 156-162
• 23 Kassab J P, Guillot R, Andre J et al.. Renal and microvascular effects of an aldose reductase inhibitor in experimental diabetes bichemical, functional and ultrastructural studies.  Biochem Pharmacol. 1994;  48 1003-1008
• 24 Hill M A, Larkins R G. Alterations in distribution of cardiac output in experimental diabetes in rats.  Am J Physiol. 1989;  257 571-580
• 25 Tschoepe D, Driesch E, Schwippert B et al.. Exposure of adhesion molecules on activated platelets in patients with newly diagnosed IDDM is not normalized by near-normoglycemia.  Diabetes. 1995;  44 890-894
• 26 Tschoepe D, Roesen P, Schwippert B et al.. Platelets in diabetes: the role in hemostatic regulation in atherosclerosis.  Semin Thromb Hemost. 1993;  19 122-128
• 27 Colwell J A, Nair R M, Haluska P V et al.. Platelet adhesion and aggregation in diabetes mellitus.  Metabolism. 1979;  28 394-400
• 28 Colwell J A, Halushka P V, Sarji K et al.. Altered platelet function in diabetes mellitus.  Diabetes. 1976;  25 826-831
• 29 Halushka P V, Rogers R C, Loadholt C B et al.. Increased platelet thromboxane synthesis in diabetes mellitus.  J Lab Clin Med. 1981;  97 87-96
• 30 Bone A J, Gwillam D J. Animal models of insulin-dependent diabetes mellitus. In: Pickup J, Williams G Textbook of Diabetes. Milan; Blackwell Science Ltd 1997: 1-16
• 31 Gamse R, Jancso G. Reduced neurogenic inflammation in streptozotocin-diabetic rats due to microvascular changes but not to substance P depletion.  Eur J Pharmacol. 1985;  118 175-180
• 32 Frosch P J, Czarnetzki B M. Effect of retinoids on wound healing in diabetic rats.  Arch Dermatol Res. 1989;  281 424-426
• 33 Cameron N E, Cotter M A, Archibald V et al.. Antioxidant and pro-oxidant effects on nerve conduction velocity, endoneural blood flow and oxygen tension in non-diabetic and streptozotocin-diabetic rats.  Diabetologia. 1994;  37 449-459
• 34 Rao L G, Kung M S. Effect of long term and short term diabetes on the parathyroid hormone sensitive rat renal adenylate cyclase: correlation with vitamin D metabolism.  Can J Physiol Pharmacol. 1998;  66 1313-1318
• 35 Moore S A, Bohlen H G, Miller B G et al.. Cellular and vessel wall morphology of cerebral cortical arterioles after short-term diabetes in adult rats.  Blood Vessels. 1985;  22 265-277
• 36 Angel M F. The dorsal skin flap model in the rat.  Plast Reconstr Surg. 1993;  92-1203