Ischemia the last and permanent, that creating flap failure

has been considered  as one of the most severe
causative parameters leading to chronic wounds(1). Ischemia and reperfusion(I/R)
injury is a pathological situation symbolized by an early limitation of blood deliver
to a tissue come after by the succeeding return of perfusion and associated with
reoxygenation, and consequently develops a serious disequilrium of metabolic contribute
and require, creating organ  hypoxia(2). Flap
transplantation has been regarded as an essential technique in plastic surgery
to cover large defects(3), and  Skin
flaps may be pedicled, or free(4). I/R injury is frequently the last and permanent,
that  creating flap failure in plastic and reconstructive surgery  (5).

cells (MCs) synthesize histamine and inflammatory proteins that are involved in
allergic disease (6).MCs  has  a function in I/R injury in several tissues (7).
Recently several studies have been demonstrated inconsistent results  about the effect of  MCs and their  degranulation activity during  I/R in some tissues(7,8,9,10).Yang et al reported  that MC degranulation promotes  I/R injury in liver of rats(7). Georgopoulos
et al found that   administering
hydroxyzine in rat epigastric axial skin flaps before reperfusion may decreases
necrosis, and deceases neutrophils and MCs counts(8). Nishioka et al
investigated the effect of low level laser therapy(LLLT), and light emitted
diode(LED) on the viability of RSFs in rats. Nishioka et al found that both LED
and LLLT were effective in increasing viability of random skin flaps(RSF),  and also  the number of MCs and blood vessels in the
transition line of RSF compared to unirradiated group (9). Coneely  et al examined the effect of MCs  degranulation in improving anastomotic repair
in an experimental model of weakly perfused large intestine in rats. Coneely et
al observed MC stabilization(no degranulation releasing  situation of MCs) decreased  anastomotic repair in normally perfused large
intestine. Hypoperfused large intestine resulted in reduced anastomotic toughness.
conversely the adding of a MC degranulating factor improved repair in
hypoperfused large intestine  compared to
 control. Coneely et al concluded that MC
degranulation is vital for early anastomotic repair in hypoperfused large

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recently in several investigations have been demonstrated  that stem cell(SC) therapy improve viability
of ischemic flaps in animal models(10,11,12). SCs have been shown as one of the potential therapeutic agents, following many experiments in animals (10,11,12). The positive
properties of SCs have been attributed to considerable improvement of wound repair
and in the rolling velocity of SCs(11), increased in  microvascular density and red blood cell
velocity,  a marked  decrease of rolling and sticking of white
blood cells,  and  fifty percent decrease in production of Interleukin
(IL)-1 and tumor necrosis factor-? (TNF-?) under hypoxic circumstances(12),
and increased paracrine expression of vascular endothelial growth factor(VEGF)(13).
However, there was no study regarding evaluation the effect of SC therapy on transition
line of the RSF (where necrosis starts), which is an important site to reveal
the effects of SC therapy  on ischemic tissue
viability (9).

growth factors are necessary for growth and proliferation of cells (14), and
many growth factors have been identified, sequenced, and produced recombinantly(14).  In this regard chicken embryo extract (CEE) has
many growth factors that stimulate cell growth(15). This is supported by the fact
that after fertilization, a chicken develops completely in three weeks in the
egg without any externally administrated  growth factors (15).

current study we examined the effect of bone marrow mesenchymal stem cells(BMMSCs)
, and CEE alone, and in combination on the flap viability,  blood vessels 
number, and  of number of MCs
degranulation in an experimental RSF in rats  . Stem cell treatment of RSF would
increase flap survival in patients.


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