The effect of autologous platelet-rich plasma on the survival of long subdermal plexus skin flaps: Experimental study in dogs

Background: In subdermal plexus (random) skin flaps, peripheral flap necrosis remains a serious complication. Platelet-rich plasma (PRP) is rich in growth factors essential for tissue repair and has demonstrated ability to improve skin flap survival. Objective: To evaluate the effect of locally injected autologous PRP on the survival of long (lengthto-width ratio 5:1) subdermal plexus skin flaps, in dogs. Methods: In six purpose-bred beagle dogs, one dorsally based 2x10 cm skin flap was created on the abdominal wall, bilaterally. In each dog, one randomly selected flap received PRP treatment, whereas the other side flap served as control. Autologous PRP (2.5 ml), prepared using the Magellan-Medtronic platelet separator system, was immediately and equally distributed beneath the flap, through the sutures. Skin flap survival was evaluated macroscopically and by survival rate calculation on day 10 postoperatively, by Laser Doppler Flowmetry measurements of tissue perfusion on days 0,2,4,6,10, and histologically on days 4,10. Results: PRP-treated flaps had a survival rate of 96.3%, whereas controls had 79.7% (P > 0.05). Tissue perfusion was significantly higher in PRP-treated flaps than in controls on days 4, 6 and 10 (P= 0.036, 0.013 and 0.003, respectively). Histologic evaluation revealed lesser edema and greater collagen production on day 10 (P = 0.01 and 0.011, respectively) in favor of PRP. The number of new vessels did not differ significantly between the two groups. Conclusion: The use of locally injected autologous PRP seems to improve the survival of long subdermal plexus skin flaps, in dogs.