Training Method of Split-thickness Skin Grafts to Hypoxic Conditions Due to the Compromised Microcirculation

Abstract

Relevance.  One of the main reasons for the existence of non-healing wounds is defeated microvasculature and tissue hypoxia develops against the background of systemic diseases. Purpose of the study . Develop a method for the preparation of split-thickness skin grafts by increasing the concentration of endogenous cytokine HIF-1α on the background of the local circulatory compensated hypoxia to increase the effectiveness of treatment of patients with nonhealing wounds of soft tissues. Materials and methods.  The hypothesis was that when a skin graft hypoxic preconditioning is an increase in the concentration of HIF-1α, which provides the best conditions for the survival of skin graft in the compromised microcirculation. Criteria to assess the correctness of the hypothesis, data were linked immunosorbent assay and results of clinical trials. In an experiment carried out on rats slit and mobilizing skin graft in animal hip controlled microcirculation to simulate hypoxic preconditioning donor area. After exposure for 30 minutes and 24 hours was performed immunoassay skin samples were subjected to hypoxic preconditioning symmetrical sections and samples of the animal's body. In the clinical part of the study analyzed the surgical treatment of 38 patients with diabetic foot. Patients underwent surgery with split-thickness skin grafts in the traditional way in the control group (20 patients), developed method used in the study group 18 patients. Results.  The concentration of HIF-1α after 30 minutes in the mobilized flap is significantly more in comparison with those obtained from the symmetrical region of the left thigh. After 24 hours concentration HIF-1α increase. According to the results of clinical research data developed method of hypoxic preconditioning of the split-thickness skin grafts its effective adaptation to the conditions of compromised microcirculation, which leads to a statistically significant increase in the area of engraftment 72 (65; 79) to 84% (78; 93)% (p = 0.012). Conclusions.  According to the immunoassay conditions in the local circulatory hypoxia at lower index of microcirculation to 50% of the original concentration of an increase in HIF-1α donor tissue area has a positive effect on graft survival.