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Clin Hemorheol Microcirc. 2015;59(4):335-43. doi: 10.3233/CH-131803.

Protective effects of activated protein C (APC) on free groin flaps after secondary venous stasis in the rat model.

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Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Consultant for Lymphology of the Surgical Clinic Munich Bogenhausen, Munich, Germany.



The goal of this study was to determine whether the focused delivery of APC by rinsing of free adipocutaneous groin flaps shows protective effects on flap survival following a fatal secondary venous stasis in a rat model.


36 Sprague Dawley rats were randomized to three groups and free microvascular groin flaps were transplanted to the neck in each animal. 20 hours postoperatively the flap pedicle was re-explored and the distal stump of the flap artery was catheterised. Animals in group I (n = 12) remained untreated, whereas animals of group II were treated with 1 ml of Ringer's solution. Those in group III received 1 ml of APC (2 mg/kg). Afterwards the flap vein was clamped for 35 minutes. The skin of the flaps and the native contralateral groin was examined by intravital video microscopy using FITC-Dextran and CFDA-SE-labelled thrombocytes.


APC-pretreatment significantly increased the functional capillary density (FCD) of the flaps. Flap viability was 8% in group I (n = 1/12), 9% in group II (n = 1/11) and 60% in group III (n = 6/10), respectively. No partial flap loss was detected.


The focused delivery of APC resulted in significantly improved flap salvage.


APC; Activated protein C; I/R; IVM; free flap; groin flap; intravital microscopy; ischemia; microsurgery; rat model; reperfusion

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