Head and neck cancer surgeons are often faced with the challenge of managing previously irradiated soft tissue that has poor vascularity and slower epithelialization. This study investigates the effect of supplemental basic fibroblast growth factor (bFGF) on flap vascularity, tissue oxygenation, and epidermal regeneration in nonirradiated (n = 40) and irradiated porcine skin flaps (n = 40). Supplemental bFGF increased vascularity in nonirradiated flaps by 80% (p = .005), with a trend to a higher tissue oxygen level by day 14. The irradiated bFGF-treated flaps did not show increased vascularity or higher tissue oxygen levels 2 weeks after surgery. However, in both irradiated and nonirradiated groups, epidermal regeneration increased by greater than 70% with supplemental bFGF (p lt; .002). The results of this study suggest that supplemental bFGF can increase tissue vascularity in nonirradiated tissues and epidermal regeneration in both nonirradiated and irradiated conditions.
HabelDW. Surgical complications in irradiated patients. Arch Otolaryngol1967;82: 382–6.
2.
TibbsM. Wound healing following radiation therapy: a review. Radiother Oncol1997;42: 99–106.
3.
Van MeterK. Baromedicine as an aid in resolution of chronic wounds. J Geriatr Dermatol1996;4: 210–25.
4.
JonssonKHuntTKMathesSJ. Oxygen as an isolated variable influences resistance to infection. Ann Surg1988;208: 783–7.
5.
KnightonDRHallidayBHuntTK. Oxygen as an antibiotic: the effect of inspired oxygen on infection. Arch Surg1984;119: 199–204.
6.
BoykinJV. Hyperbaric oxygen therapy: a physiologic approach to selected wound healing. Wounds1996;8: 183–98.
7.
KnightonDRSilverIAHuntTK. Regulation of wound healing angiogenesis — effect of oxygen gradients and inspired oxygen concentration. Surgery1981: 90: 262–70.
8.
ImMJKimYSEdwardsRJHoopesJEFenselauA. The effect of bovine basic fibroblast growth factor on skin flap survival in rats. Ann Plast Surg1992;28: 242–5.
9.
IshiguroNYabeYShimizuTIwataHMiuraT. Basic fibroblast growth factor has a beneficial effect on the viability of random skin flaps in rats. Ann Plast Surg1994: 32: 356–60.
KhouriRKBrownDMLeal-KhouriSMTarkKCShawWW. The effect of basic fibroblast growth factor on the neovascularization process: skin flap survival and staged flap transfers. Br J Plast Surg1991;44: 585–8.
12.
HomDBAssefaG. Effects of endothelial cell growth factor on vascular compromised skin flaps. Arch Otolaryngol1992;118: 624–8.
13.
SlavinJHuntJANashJRWilliamsDFKingsnorthAN. Recombinant basic fibroblast growth factor in red blood cell ghosts accelerates incisional wound strength. Br J Surg1992: 19: 918–21.
14.
DrakeDBOishiS. Wound healing considerations in chemotherapy and radiation therapy. Clin Plast Surg1995;22: 31–7.
15.
DimitrievichGSFischer-DzogaKGriemM. Radiosensitivity of vascular tissue. I. Differential radiosensitivity of capillaries: a quantitative in vivo study. Radiat Res1984: 99: 511–34.
16.
DoyleJWLiYSalloumAFitzgeraldTJWaltonRL. The effects of radiation on neovascularization in a rat model. Plast Reconstr Surg1996: 98: 129–35.
17.
LancasterJFLeaperDJ. Effects of inhalational anaesthetic agents on oxygen electrodes. Eur Surg Res1987: 19: 1–12.
18.
HjortdalVETimmengaEJKnolsethD. Continuous direct tissue oxygen tension measurement. Ann Chir Gynaecol1991: 80: 8–13.
19.
HopfHWHuntTK. Comparison of Clark electrode and optode for measurement of tissue oxygen tension. Adv Exp Med Biol1994: 345: 841–7.
20.
HoferSOPTimmengaEJFChristianoRBosKE. An intravascular oxygen tension monitoring device used in myocutaneous transplants: a preliminary report. Microsurgery1993;14: 304–9.
ChangHSHomDB. Agarwal RP, Pernell K, Manivel JC, Chang S. Effects of basic fibroblast growth factor on irradiated porcine skin flaps. Arch Otolaryngol Head Neck Surg1998;124: 307–12.
23.
EroiOSpiraMLevyB. Microangiography: a detailed technique of perfusion. J Surg Res1980;29: 406–13.
24.
PandaDPRosenfeldA. Image segmentation by pixel classification in gray level, edge value space. IEEE Trans Comput1978: C-27: 875–80.
25.
ThackrayBDNelsonAC. Semi-automatic segmentation of vascular network images using a rotating structure element (ROSE) with mathematical morphology and dual feature thresholding. IEEE Trans Med Imaging1993;12: 385–92.
26.
HuntTKPaiMP. Effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet1972;135: 561–7.
27.
GoodsonWHuntT. Wound healing. In: KinneyJ, ed. Nutrition and metabolism in patient care. Philadelphia, Pa: WB Saunders, 1988: 635–42.
28.
NemiroffPM. Hyperbaric oxygen in skin grafts and flaps. In: KindwallEP, ed. Hyperbaric medicine practice. Flagstaff, Ariz: Best Publishing Co, 1995: 566–79.
29.
RemensnyderJ. Oxygen gradients in healing wounds. Am J Pathol1968;52: 302–8.
30.
HuntTKTwomeyPZederfeldtBDunphyJE. Respiratory gas tension and pH in healing wounds. Am J Surg1967;114: 302–7.
31.
DavisJCBuckleyCJBarrPO. Compromised soft tissue wounds: correction of wound hypoxia. In: DavisJCHuntTK, eds. Problem wounds: the role of oxygen. New York, NY: Elsevier, 1988: 143–4.
32.
CalderonWChangKNMathesSJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fascio-cutaneous flaps. Plast Reconstr Surg1986;77: 785–92.
33.
Haimovitz-FriedmanAVlodavskyIChanhuriAWitteLFuksZ. Autocrine effects of fibroblast growth factor in repair of damage in endothelial cells. Cancer Res1991;51: 2552–8.
MustoeTAAhnSTTarpleyJEPierceGF. Role of hypoxia in growth factor responses: differential effects of basic fibroblast growth factor and platelet derived growth factor in an ischemic wound model. Wound Repair Regeneration1994;2: 277–83.
WuLPierceGFLadinDAZhaoLLRogersDMustoeTA. Effects of oxygen on wound responses to growth factors: Kaposi's FGF, but not basic FGF, stimulates repair in ischemic wounds. Growth Factors1995;12: 29–35.
38.
ReinholdHSBuoismanGH. Radiosensitivity of capillary endothelium. Br J Radiol1973;46: 54–7.
39.
O'KeefeEJChinMLPayneRE. Stimulation of keratinocytes by basic fibroblast growth factor. J Invest Dermatol1988;90: 767–9.
40.
ShipleyGDKeebleWWHendricksonJECoffeyRJPittelkowMR. Growth of normal human keratinocytes and fibroblasts is stimulated by acidic and basic fibroblast growth factor. J Cell Physiol1989;138: 511–8.
41.
HebdaPAKlingbeilCKAbrahamJAFiddesJC. Basic fibroblast growth factor stimulation of epidermal wound healing in pigs. J Invest Dermatol1990;95: 626–31.
42.
ErikssonEBreuingKJohansenLBMillerDR. Growth factor solutions for wound treatment in pigs. Surg Forum1989;40: 618–20.
