Drug Design, Development and Therapy (Feb 2021)

Trans-Cinnamaldehyde Increases Random Pattern Flap Survival Through Activation of the Nitric Oxide Pathway

  • Luo X,
  • Zhao B,
  • Chen B,
  • Chen H,
  • Han T,
  • Bsoul NBN,
  • Yan H

Journal volume & issue
Vol. Volume 15
pp. 679 – 688

Abstract

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Xiaobin Luo,1 Bin Zhao,2 Baoxia Chen,2 Hongyu Chen,1 Tao Han,1 Najeeb Bassam Najeeb Bsoul,1 Hede Yan1 1Department of Orthopedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People’s Republic of China; 2Department of Post Anaesthesia Care Unit, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People’s Republic of ChinaCorrespondence: Hede YanDepartment of Orthopaedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, West Xueyuan Road 109#, Wenzhou, 325027, Zhejiang Province, People’s Republic of ChinaEmail [email protected]: The application of random pattern skin flaps is limited in plastic surgery reconstruction due to necrosis. Trans-cinnamaldehyde has antibacterial, anticancer, and antioxidant properties. In this study, we aimed to investigate the effect of trans-cinnamaldehyde on skin flap survival and its possible mechanism regarding nitric oxide.Materials and Methods: One hundred forty male Sprague-Dawley rats were randomly divided into seven groups (n = 20 each group). After the dorsal flap was raised, different doses of trans-cinnamaldehyde (10, 20, and 30 mg/kg) were immediately given by oral gavage in the three different groups. To assess the possible involvement of the nitric oxide system, NG-nitro-L-arginine methyl ester (L-NAME, a nonselective nitric oxide synthase inhibitor) was used in this study. All flap samples were incised on postoperative day 7.Results: Our results showed that flap survival was increased significantly in the 20 mg/kg (P < 0.001) trans-cinnamaldehyde (TC) group compared to the control group or 30 mg/kg TC group. This protective function was restrained by coadministration of L-NAME with 20 mg/kg TC. The results of histopathology, laser Doppler, arteriography mediated with oxide–gelatine, and fluorescent staining all showed a significant increase in capillary count, collagen deposition, angiogenesis, and flap perfusion. Immunohistochemistry results revealed a significant increase in the expression of CD34, eNOS, and VEGF.Conclusion: Trans-cinnamaldehyde increased flap survival through the nitric oxide synthase pathway and contributed to angiogenesis. A concentration of 20 mg/kg trans-cinnamaldehyde was recommended in this study.Keywords: random pattern flap, flap necrosis, trans-cinnamaldehyde, angiogenesis, flap perfusion

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