Cold Atmospheric Plasma, Platelet-Rich Plasma, and Nitric Oxide Synthesis Inhibitor: Effects Investigation on an Experimental Model on Rats

Featured Application Potential use in flap surgery, towards growing flap viability, diminishing marginal, or partial flap necrosis, as well as shortening the waiting period for angiogenesis in pedicled or tubulised flaps before second stage reconstruction. The evolution of reconstructive methods for defects of the human body cannot yet replace the use of flap surgery. Research is still preoccupied with the ideal techniques for offering the best chances of survival of the flaps. In our study, we investigated the effects of cold atmospheric plasma (CAP), N-nitro-L-arginine methyl ester (L-NAME), and platelet-rich plasma (PRP) injectable solutions on flap survival using an in vivo model. Twenty-four Wistar rats (four groups) had the McFarlane flap raised and CAP, L-NAME, and PRP substances tested through a single dose subcutaneous injection. The control group had only a saline solution injected. To the best of our knowledge, this is the first study that evaluated a CAP activated solution through injection on flaps. The flap survival rate was determined by clinical examination (photography documented), hematology, thermography, and anatomopathological tests. The image digital analysis performed on the flaps showed that the necrosis area (control-49.64%) was significantly lower for the groups with the three investigated solutions: CAP (14.47%), L-NAME (18.2%), and PRP (23.85%). Thermography exploration revealed less ischemia than the control group on the CAP, L-NAME, and PRP groups as well. Anatomopathological data noted the best degree of angiogenesis on the CAP group, with similar findings on the L-NAME and PRP treated flaps. The blood work did not indicate infection or a strong inflammatory process in any of the subjects. Overall, the study shows that the CAP activated solution has a similar (better) impact on the necrosis rate (compared with other solutions with known effects) when injected on the modified dorsal rat skin flap, and on top of that it can be obtained fast, in unlimited quantities, non-invasively, and through a standardized process.

Automated summary

This study investigated the effects of cold atmospheric plasma (CAP), L-NAME, and PRP injectable solutions on flap survival. The results showed that the necrosis area of the flaps was significantly lower in the CAP, L-NAME, and PRP groups compared to the control group. Thermography exploration also revealed less ischemia in the treated groups. Additionally, anatomopathological data indicated that the CAP group had the best degree of angiogenesis. Overall, the CAP activated solution had a similar (or even better) impact on flap necrosis rate and offered fast, unlimited, non-invasive, and standardized treatment.