富血小板血浆术后不同干预时机对大鼠随意 皮瓣成活的影响

Effect of Platelet-Rich Plasma Administered at Different Postoperative Time Points on the Survival of Random-Pattern Skin Flaps in Rats

摘要: 目的：观察富血小板血浆(platelet-rich plasma, PRP)不同术后干预时机对大鼠随意皮瓣成活的影响，并比较术后即刻给药后再于术后第3天追加PRP的干预效果。方法：采用改良McFarlane大鼠背部随意皮瓣模型。实验动物随机分为空白组、术后即刻组、术后第1天组、术后即刻 + 术后第3天组和术后第3天组，于相应时间点给予PRP干预。术后第7天观察测定皮瓣坏死率，并采用Western blot检测Caspase-1、IL-1β和IL-18蛋白表达。结果：各PRP干预组皮瓣坏死范围均较空白组缩小。预设比较显示，术后即刻组坏死率低于空白组，术后即刻 + 术后第3天组坏死率进一步低于术后即刻组(均P < 0.05)。Western blot结果显示，IL-1β、IL-18和Caspase-1组间总体差异均有统计学意义(均P < 0.05)。其中，术后即刻 + 术后第3天组IL-1β和Caspase-1水平进一步降低，而IL-18主要表现为空白组与各干预组之间差异。结论：PRP不同术后干预时机与大鼠随意皮瓣成活结局相关。术后即刻给药可改善皮瓣成活，在此基础上于术后第3天追加一次干预，可进一步降低坏死率。

Abstract: Objective: To determine whether the postoperative timing of PRP administration affects random-pattern skin flap survival in rats, and whether an additional dose on postoperative day 3 provides further benefit after immediate treatment. Methods: A modified McFarlane dorsal random-pattern skin flap model was established in rats. Animals were assigned to an untreated group, an immediate postoperative PRP group, a postoperative day 1 PRP group, an immediate postoperative plus postoperative day 3 PRP group, and a postoperative day 3 PRP group. PRP was administered at the designated time points. Flap necrosis rate was assessed on postoperative day 7. Caspase-1, IL-1β, and IL-18 protein expression was measured by Western blot. Results: Flap necrotic area was smaller in all PRP intervention groups than in the untreated group. Planned comparisons showed that immediate postoperative PRP reduced the necrosis rate versus the untreated group, while immediate postoperative PRP plus an additional POD3 treatment further reduced necrosis versus immediate postoperative PRP alone (both P < 0.05). Western blot results showed that IL-1β, IL-18, and Caspase-1 expression also differed significantly among groups overall (all P < 0.05). In the immediate postoperative plus postoperative day 3 group, IL-1β and Caspase-1 levels were lower than those in the three single-treatment groups, whereas IL-18 mainly differed between the untreated group and the PRP-treated groups. Conclusion: The effect of PRP on flap survival in this rat model varied with postoperative timing. Immediate postoperative treatment improved flap survival, and an additional dose on postoperative day 3 further reduced flap necrosis.