2023, Vol. 27 ›› Issue (11): 1659-1668

Intervention with platelet-rich fibrin in rabbit models after microvascular anastomosis surgery of the femoral artery: changes in vascular structure and soft tissue

Lu Yangyang, Yan Ruihong, Qiu Zhongpeng, Dai Yi, Wang Zixin, Wang Weishan, Shi Chenhui, Du Xinhui, Li Gang   

Abstract: BACKGROUND: Recently, numerous basic and clinical data have shown the superiority of platelet-rich fibrin in the regeneration and repair of soft and hard tissues, while there are few relevant reports in the field of microvascular anastomosis.  
OBJECTIVE: To evaluate the efficacy of platelet-rich fibrin applied to the femoral artery after microvascular anastomosis surgery in a rabbit model.  
METHODS: Thirty-six adult New Zealand white rabbits of either sex were randomly divided into experimental group and control group (n=18 per group) after establishing femoral artery transection-reanastomosis models. In the experimental group, autologous ear venous blood were extracted and centrifuged to prepare platelet-rich fibrin gel, and the prepared gel was immediately applied to the anastomotic site of the femoral artery. The control group was given the same volume of normal saline. Incision infection, healing, and adhesion were evaluated at 3, 7, 14 days after surgery. Vascular structure of the femoral artery at the anastomotic site was observed using hematoxylin-eosin staining. Immunohistochemistry detection was performed to analyze the expression levels of vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor β1.
RESULTS AND CONCLUSION: The overall number of incision infections in the experimental group was lower than that in the control group animals (P < 0.05), and the number of incision infections showed no significant changes in each group (P > 0.05). The overall incision healing level in the experimental group was better than that in the control group (P < 0.05), and the incision healing showed no significant changes in the experimental group (P > 0.05) but changed significantly in the control group at different time points (P < 0.05). The degree of femoral artery adhesion in the operation area was generally lighter in the experimental group than the control group (P < 0.05). The degree of adhesion had insignificant changes in the experimental group at different time points (P > 0.05) but gradually increased in the control group after operation (P < 0.05). The results of hematoxylin-eosin staining showed better repair of vascular endothelial cells and inner elastic lamina in the experimental group than the control group. Compared with the control group, the reconstruction of the intima was more complete in the experimental group, with less necrosis, proliferation, and migration of vascular smooth muscle cells in the media and traumatic hyperplasia of the extima. The overall healing condition of the vascular wall was better in the experimental group than the control group. Immunohistochemical results revealed that the expression levels of vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor β1 in the experimental group were higher than those in the control group (P < 0.05). To conclude, platelet-rich fibrin can promote the growth of vascular endothelial cells, contribute to the in situ reconstruction of various layers of vascular tissue, reduce postoperative complications, such as infection and adhesion, in the surgical area, and shorten the repair and healing time after vascular injury. This novel treatment method is expected to improve the therapeutic effect of arterial anastomosis in microsurgery.
Key words: blood concentrate, platelet-rich fibrin, growth factor, microsurgery, microvascular anastomosis, vascular endothelial cell injury, thrombus, revascularization