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Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis

BACKGROUND: A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of...

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Autores principales: Li, Yuan, Jiang, Qi-lin, Van der Merwe, Leanne, Lou, Dong-hao, Lin, Cai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791712/
https://www.ncbi.nlm.nih.gov/pubmed/33413598
http://dx.doi.org/10.1186/s13287-020-02103-w
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author Li, Yuan
Jiang, Qi-lin
Van der Merwe, Leanne
Lou, Dong-hao
Lin, Cai
author_facet Li, Yuan
Jiang, Qi-lin
Van der Merwe, Leanne
Lou, Dong-hao
Lin, Cai
author_sort Li, Yuan
collection PubMed
description BACKGROUND: A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. METHODS: This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. RESULTS: Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). CONCLUSIONS: The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.
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spelling pubmed-77917122021-01-11 Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis Li, Yuan Jiang, Qi-lin Van der Merwe, Leanne Lou, Dong-hao Lin, Cai Stem Cell Res Ther Review BACKGROUND: A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. METHODS: This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. RESULTS: Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). CONCLUSIONS: The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis. BioMed Central 2021-01-07 /pmc/articles/PMC7791712/ /pubmed/33413598 http://dx.doi.org/10.1186/s13287-020-02103-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Li, Yuan
Jiang, Qi-lin
Van der Merwe, Leanne
Lou, Dong-hao
Lin, Cai
Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title_full Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title_fullStr Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title_full_unstemmed Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title_short Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
title_sort preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791712/
https://www.ncbi.nlm.nih.gov/pubmed/33413598
http://dx.doi.org/10.1186/s13287-020-02103-w
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