Zhang Feng, Lineaweaver William
Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
Ann Plast Surg. 2011 May;66(5):581-2. doi: 10.1097/SAP.0b013e3182057376.
Over the past 15 years, we have completed 10 experimental studies of the effects of vascular endothelial growth factor (VEGF) on the survival of flaps and skin grafts. We have reviewed these studies to summarize evidence for 2 distinct phases of VEGF actions. The 10 studies were reviewed and classified as demonstrating acute VEGF effects (with VEGF administered at the time of procedures) or sustained VEGF effects (with VEGF administered 24 hours or more before procedures). Acute effects of VEGF included increased survival of skin flaps, muscle flaps, and full thickness skin grafts, increased viability markers in hind limb replants, selective cytokine suppression, and variable modulation of nitric oxide synthase expression. Sustained VEGF effects included extension of skin flap territories, accelerated maturation of tubed pedicle flaps, and increased neovascularization. VEGF effects coincide with descriptive mechanisms of tissue survival. The acute VEGF effects of tissue edema and vasodilation parallel serum imbibition and inosculation. The sustained VEGF effect of neovascularization may be mechanisms of permanent tissue survival at new sites, as well as delay phenomena. Manipulation of these VEGF effects could lead to strategies for achieving greater predictability in flap and graft survival.
在过去15年里，我们完成了10项关于血管内皮生长因子（VEGF）对皮瓣和皮肤移植成活率影响的实验研究。我们对这些研究进行了回顾，以总结VEGF作用两个不同阶段的证据。对这10项研究进行了回顾并分类为证明VEGF的急性作用（在手术时给予VEGF）或持续VEGF作用（在手术前24小时或更长时间给予VEGF）。VEGF的急性作用包括皮瓣、肌皮瓣和全层皮肤移植成活率增加，断肢再植中活力标志物增加，选择性细胞因子抑制，以及一氧化氮合酶表达的可变调节。VEGF的持续作用包括皮瓣区域扩大、带蒂管状皮瓣成熟加速和新生血管形成增加。VEGF的作用与组织存活的描述性机制一致。组织水肿和血管舒张的急性VEGF作用与血清吸收和吻合相对应。新生血管形成的持续VEGF作用可能是新部位永久组织存活的机制，以及延迟现象。对这些VEGF作用的操控可能会带来提高皮瓣和移植成活率可预测性的策略。
