The Effect of Platelete Rich Plasma Combined with Microneedling on Full Venous Outflow Compromise in a Rat Skin Flap Model

The complications related to obstructed venous outflow are common in flap transfer ¹. Microneedling aims to induce as many microwounds in the dermis initiates the normal phases of wound healing. Platelet rich plasma (PRP) is a rich source of growth factors, has been found effective in accelerating significant tissue repair and regeneration, and releases massive quantities of platelet growth factors.  The purpose of our study is to determine the efficiency of microneedling and PRP enriche.d microneedling method for alleviating the harmful effect of venous congestion.

Rats were numbered and randomized into five groups: sham group (n=8): the elevated skin flap was repositioned without an episode of ischemia. Control group (n=8): four hours of complete ischemia was induced by clamping the venous pedicle of flapMicroneedling group (n=8): four hours of complete ischemia was induced and the end of ischemia, the microneedling procedure was performed (PRP enriched microneedling group (n=8): at the end of ischemia, the microneedling procedure was first performed and then 1,5 ml PRP were applied. Plasma enriched microneedling group: (n=8): at the end of ischemia, the microneedling procedure was performed and then 1,5 ml plasma were applied. The areas of intact skin and necrosis were recorded and full-thickness skin samples were excised on Day 7.

In sham group and the microneedling +PRP group, all flaps were survived. Statistical datas of groups were given in table 1. The surviving flap area of the control group was found to be significantly lower. In microneedling group, there was intensive inflammatory response in the dermal layer and there was still disorganisation at the dermal and epidermal junction. In microneedling+PRP group, epidermal and dermal layers were organized, dermal and epidermal conjuction was easily seen and collagen fibers were organized (figure 1). Our study shows that using PRP enriched microneedling method have significant effect on venous outflow compromise.

Table 1. Datas of study.

	Group										P value
	Microneedling		Plasma		PRP		Control		Sham
	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Total flap area	10,33	2,02	7,17	1,95	9,08	2,07	5,45	3,04	9,35	0,92	<0.001*
Necrosis	0,71	0,56	0,63	0,66	0,00	0,00	2,09**	1,90	0,00	0,00	<0.001*
Intact flap area	9,59	2,28	6,56	1,95	9,08	2,07	3,26**	4,52	9,35	0,92	<0.001*

Figure 1.

Venous ischemia

PRP enriched microneedling group