Akdemir Ovunc, Eyuboglu Atilla, Cetin Emel Oyku, Uyanikgil Yigit
Department of Plastic, Aesthetic and Reconstructive Surgery, Istanbul Aydin University, Istanbul, Turkey.
Department of Plastic, Aesthetic and Reconstructive Surgery, Istanbul Arel University, Istanbul, Turkey.
J Invest Surg. 2025 Dec;38(1):2528341. doi: 10.1080/08941939.2025.2528341. Epub 2025 Jul 11.
Ischemia-reperfusion injury is a well-recognized challenge in reconstructive flap surgery, often leading to partial or total tissue necrosis. In this experimental study, we aimed to evaluate the protective effects of lutein-a non-provitamin A carotenoid known for its antioxidant and anti-inflammatory actions-against ischemia-reperfusion -induced damage in a rat epigastric flap model.
Sixteen Sprague-Dawley rats were randomized to receive either intraperitoneal lutein (0.5 mg/kg) or saline prior to inducing 10 h of ischemia. Flap viability was assessed macroscopically on postoperative day 10, and biochemical and histopathological analyses were conducted to explore underlying mechanisms.
Compared to controls, lutein-treated animals demonstrated significantly larger flap survival areas (21.18 ± 0.88 cm vs. 8.42 ± 1.15 cm, < 0.05), lower malondialdehyde levels ( < 0.01) and myeloperoxidase levels ( < 0.05), and higher glutathione ( < 0.05) and nitric oxide concentrations ( < 0.01), suggesting reduced oxidative stress and improved vascular function. Histological examination revealed less necrosis, edema, and neutrophil infiltration in the Lutein group, alongside enhanced fibroblast activity, collagen deposition, and neovascularization. Additionally, increased epidermal thickness and a notable rise in lymphocyte infiltration indicated the potential modulation of the adaptive immune response during repair.
Taken together, our findings suggest that lutein exerts a multifaceted protective effect on ischemic flap tissue and may serve as a useful adjunct in reconstructive surgery, particularly in settings with high risk of ischemia-reperfusion injury. Given its safety and supplement status, these preclinical findings support further exploration in human studies.
缺血再灌注损伤是重建皮瓣手术中一个公认的挑战，常导致部分或全部组织坏死。在本实验研究中，我们旨在评估叶黄素（一种以其抗氧化和抗炎作用而闻名的非维生素A类胡萝卜素）对大鼠腹壁皮瓣模型中缺血再灌注诱导损伤的保护作用。
16只Sprague-Dawley大鼠在诱导10小时缺血前随机接受腹腔注射叶黄素（0.5mg/kg）或生理盐水。术后第10天宏观评估皮瓣活力，并进行生化和组织病理学分析以探索潜在机制。
与对照组相比，叶黄素处理的动物皮瓣存活面积显著更大（21.18±0.88cm²对8.42±1.15cm²，P<0.05），丙二醛水平更低（P<0.01）和髓过氧化物酶水平更低（P<0.05），以及更高的谷胱甘肽水平（P<0.05）和一氧化氮浓度（P<0.01），表明氧化应激减轻且血管功能改善。组织学检查显示叶黄素组坏死、水肿和中性粒细胞浸润较少，同时成纤维细胞活性增强、胶原沉积和新生血管形成增加。此外，表皮厚度增加和淋巴细胞浸润显著增加表明修复过程中适应性免疫反应可能受到调节。
综上所述，我们的研究结果表明叶黄素对缺血皮瓣组织具有多方面的保护作用，并且可能作为重建手术中的有用辅助手段，特别是在缺血再灌注损伤风险高的情况下。鉴于其安全性和补充剂地位，这些临床前研究结果支持在人体研究中进一步探索。
