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December 1988, Vol 114, No. 12 >
ARTICLE | December 1988

Improved Survival of Acute Skin Flaps With Amino Acids as Free Radical Scavengers FREE

Randal C. Paniello, MD; Richard E. Hayden, MD; Steven L. Bello, MD
[+] Author Affiliations

Accepted for publication Aug 15, 1988.

Presented at the spring meeting of the American Society for Head and Neck Surgery, Denver, April 28, 1987.

Reprint requests to Department of Otolaryngology, Washington University School of Medicine, Box 8115, 517 S Euclid, St Louis, MO 63110 (Dr Hayden).


Arch Otolaryngol Head Neck Surg. 1988;114(12):1400-1403. doi:10.1001/archotol.1988.01860240050022
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Comments

• Oxygen-derived free radicals have been shown to be important mediators in ischemia-reperfusion injury to skin flaps. Agents that reduce the level of these free radicals have been used to improve flap survival in model systems. An in vitro study of the interactions between amino acids and hydroxyl radicals by electron spin resonance spectroscopy suggests an intrinsic radical scavenging activity of certain amino acids. The ability of these amino acids to improve acute axial-random skin flap survival was examined in a rat model. Cysteine, methionine, proline, hydroxyproline, histidine, and phenylalanine, given intravenously, significantly improved flap survival over saline controls; alanine gave an intermediate result, while aspartic acid showed no improvement. The in vitro data were generally a good predictor of free radical scavenging ability as manifested by improved flap survival in vivo. Biochemical mechanisms and clinical applications are described.

(Arch Otolaryngol Head Neck Surg 1988;114:1400-1403)

REFERENCES

1 +
McCord JM:  Free radicals and ischemia . N Engl J Med 1985;;312:159-163.
2 +
McCord JM, Roy RS:  The pathophysiology of superoxide: Role in inflammation and ischemia . Can J Physiol Pharmacol 1982;;60:1346-1352.
3 +
Del Maestro RF:  An approach to free radicals in medicine and biology . Acta Physiol Scand 1980;;492( (suppl) ):153-168.
4 +
Stewart JR, Blackwell WH, Crute SL, et al:  Prevention of myocardial ischemia/reperfusion injury with oxygen radical scavengers . Surg Forum 1982;;33:317-320.
5 +
Toledo-Pereyra LH, Simmons RL, Najarian JS:  Effect of allopurinol on the preservation of ischemic kidneys perfused with plasma or plasma substitutes . Ann Surg 1974;;180:780-782.
6 +
Baker GL, Corry RJ, Autor AP:  Oxygen-free radical-induced damage in kidneys subjected to warm ischemia and perfusion . Ann Surg 1985;; 202:628-641.
7 +
Koyama I, Bulkley GB, Williams GM, et al:  The role of oxygen free radicals in mediating the reperfusion injury of cold-preserved ischemic kidneys . Transplantation 1985;;40:590-595.
8 +
Smith DS, Rehncrona S, Siesjo BK:  Barbiturates as protective agents in brain ischemia and as free radical scavengers in vitro . Acta Physiol Scand 1980;;492( (suppl) ):129-134.
9 +
Granger DN, Rutilli G, McCord JM:  Superoxide radicals in feline intestinal ischemia . Gastroenterology 1981;;81:22-29.
10 +
Perry MA, Wadhwa S, Parks DA, et al:  Role of oxygen radicals in ischemia-induced lesions in the cat stomach . Gastroenterology 1986;;90:362-367.
11 +
Wong C, Fox R, Demling RH:  Effect of hydroxyl radical scavenging on endotoxininduced lung injury . Surgery 1985;;97:300-306.
12 +
Atalla SL, Toledo-Pereyra LH, MacKenzie GH, et al:  Influence of oxygen-derived free radical scavengers on ischemic livers . Transplantation 1985;;40:584-590.
13 +
Marubayashi S, Kiyohiko D, Ochi K, et al:  Role of free radicals in ischemic rat liver cell injury: Prevention of damage by α-tocopherol administration . Surgery 1986;;99:184-191.
14 +
Coles JC, Ahmed SN, Mehta HU, et al:  Role of free radical scavenger in protection of spinal cord during ischemia . Ann Thorac Surg 1986;; 41:551-556.
15 +
Manson PN, Anthenelli RM, Im MJ, et al:  The role of oxygen-free radicals in ischemic tissue injury in island free flaps . Ann Surg 1983;; 198:87-90.
16 +
Im MJ, Manson PN, Bulkley GB, et al:  Effects of superoxide dismutase and allopurinol on the survival of acute island skin flaps . Ann Surg 1985;;201:357-359.
17 +
Hayden RE, Paniello RC, Yeung CST, et al:  The effect of hydroxyl radical scavenging on acute axial-random skin flap survival . Laryngoscope 1988;;98:106-108.
18 +
Hayden RE, Paniello RC, Yeung CST, et al: Improvement of skin flap survival with calcium antagonists, in press.
19 +
Hayden RE, Paniello RC, Yeung CST, et al:  The effect of glutathione and vitamins A, C, and E on acute skin flap survival . Laryngoscope 1987;;97:1176-1179.
20 +
Sagi A, Ferder M, Leveas D, et al:  Improved survival of island flaps after prolonged ischemia by perfusion with superoxide dismutase . Plast Reconstr Surg 1986;;77:639-644.
21 +
Manson PN, Narayan KK, Im MJ, et al:  Improved survival in free skin flap transfers in rats . Surgery 1986;;99:211-214.
22 +
Finseth F, Cutting C:  An experimental neurovascular island flap for the study of the delay phenomenon . Plast Reconstr Surg 1986;; 61:412.
23 +
Sasaki GH, Pang CY:  Hemodynamics and viability of acute neurovascular island skin flaps in rats . Plast Reconstr Surg 1986;;65:152-158.
24 +
Nagy IZ, Floyd RA:  Hydroxyl free radical reactions with amino acids and proteins studied by electron spin resonance spectroscopy and spin-trapping . Biochim Biophys Acta 1984;; 790:238-250.
25 +
Floyd RA, Nagy IZ:  Formation of long-lived hydroxyl free radical adducts of proline and hydroxyproline in a Fenton reaction . Biochim Biophys Acta 1984;;790:94-97.
26 +
Pisarenko OI, Solomatina ES, Studneva IM:  The role of amino acid catabolism in the formation of the tricarboxylic acid cycle intermediates and ammonia in anoxic rat heart . Biochim Biophys Acta 1986;;885:154-161.
27 +
Romson JL, Hook BG, Kunkel SL, et al:  Reduction of the extent of ischemic myocardial injury by neutrophil depletion in the dog . Circulation 1983;;67:1016.
28 +
Mitsos SE, Askew TE, Fantone JC, et al:  Protective effects of N-2-mercaptopropionyl glycine against myocardial reperfusion injury after neutrophil depletion in the dog: Evidence for the role of intracellular-derived free radicals . Circulation 1986;;73:1077-1086.
29 +
Korthuis RJ, Granger DN, Townsley MI, et al:  The role of oxygen-derived free radicals in ischemia-induced increases in canine skeletal muscle vascular permeability . Circ Res 1985;; 57:599-609.
30 +
Dean RT, Pollak JK:  Endogenous free radical generation may influence proteolysis in mitochondria . Biochem Biophys Res Commun 1985;;126:1082-1089.
31 +
Boveris A:  Mitochondrial production of superoxide radical and hydrogen peroxide . Adv Exp Med Biol 1977;;78:67-82.
32 +
Rau EE, Shine KI, Gervais A, et al:  Enhanced mechanical recovery of anoxic and ischemic myocardium by amino acid perfusion . Am J Physiol 1979;;236:H873-879.
33 +
Wright G:  Amino acids in the treatment of ischemic heart disease . J Mol Cell Cardiol 1985;; 17:441-443.
34 +
Adams GE, Aldrich JE, Bisby RH, et al:  Selective free radical reactions with proteins and enzymes: Reactions of inorganic radical anions with amino acids . Radiat Res 1972;;49:278-289.
35 +
Land EJ, Prutz WA:  Reaction of azide radicals with amino acids and proteins . Int J Radiat Biol 1979;;36:75-83.
36 +
Tamba M, Badiello R:  Reactions of selenium dioxide free radicals with amino acids and enzymes . Int J Radiat Biol 1985;;48:259-270.
37 +
Hoey BM, Butler J:  The repair of oxidized amino acids by antioxidants . Biochim Biophys Acta 1984;;791:212-218.
38 +
Martensson J:  The effect of fasting on leukocyte and plasma glutathione and sulfur amino acid concentrations . Metabolism 1986;; 35:118-121.
39 +
Hahn R, Wendel A, Flohe L:  The fate of extracellular glutathione in the rat . Biochim Biophys Acta 1978;;539:324-337.
40 +
Sepulveda FV, Burton KA, Brown PD:  Calcium movements accompanying transport of sugar or amino acids by rabbit enterocytes . Biochim Biophys Acta 1986;;856:185-187.

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1 +
McCord JM:  Free radicals and ischemia . N Engl J Med 1985;;312:159-163.
2 +
McCord JM, Roy RS:  The pathophysiology of superoxide: Role in inflammation and ischemia . Can J Physiol Pharmacol 1982;;60:1346-1352.
3 +
Del Maestro RF:  An approach to free radicals in medicine and biology . Acta Physiol Scand 1980;;492( (suppl) ):153-168.
4 +
Stewart JR, Blackwell WH, Crute SL, et al:  Prevention of myocardial ischemia/reperfusion injury with oxygen radical scavengers . Surg Forum 1982;;33:317-320.
5 +
Toledo-Pereyra LH, Simmons RL, Najarian JS:  Effect of allopurinol on the preservation of ischemic kidneys perfused with plasma or plasma substitutes . Ann Surg 1974;;180:780-782.
6 +
Baker GL, Corry RJ, Autor AP:  Oxygen-free radical-induced damage in kidneys subjected to warm ischemia and perfusion . Ann Surg 1985;; 202:628-641.
7 +
Koyama I, Bulkley GB, Williams GM, et al:  The role of oxygen free radicals in mediating the reperfusion injury of cold-preserved ischemic kidneys . Transplantation 1985;;40:590-595.
8 +
Smith DS, Rehncrona S, Siesjo BK:  Barbiturates as protective agents in brain ischemia and as free radical scavengers in vitro . Acta Physiol Scand 1980;;492( (suppl) ):129-134.
9 +
Granger DN, Rutilli G, McCord JM:  Superoxide radicals in feline intestinal ischemia . Gastroenterology 1981;;81:22-29.
10 +
Perry MA, Wadhwa S, Parks DA, et al:  Role of oxygen radicals in ischemia-induced lesions in the cat stomach . Gastroenterology 1986;;90:362-367.
11 +
Wong C, Fox R, Demling RH:  Effect of hydroxyl radical scavenging on endotoxininduced lung injury . Surgery 1985;;97:300-306.
12 +
Atalla SL, Toledo-Pereyra LH, MacKenzie GH, et al:  Influence of oxygen-derived free radical scavengers on ischemic livers . Transplantation 1985;;40:584-590.
13 +
Marubayashi S, Kiyohiko D, Ochi K, et al:  Role of free radicals in ischemic rat liver cell injury: Prevention of damage by α-tocopherol administration . Surgery 1986;;99:184-191.
14 +
Coles JC, Ahmed SN, Mehta HU, et al:  Role of free radical scavenger in protection of spinal cord during ischemia . Ann Thorac Surg 1986;; 41:551-556.
15 +
Manson PN, Anthenelli RM, Im MJ, et al:  The role of oxygen-free radicals in ischemic tissue injury in island free flaps . Ann Surg 1983;; 198:87-90.
16 +
Im MJ, Manson PN, Bulkley GB, et al:  Effects of superoxide dismutase and allopurinol on the survival of acute island skin flaps . Ann Surg 1985;;201:357-359.
17 +
Hayden RE, Paniello RC, Yeung CST, et al:  The effect of hydroxyl radical scavenging on acute axial-random skin flap survival . Laryngoscope 1988;;98:106-108.
18 +
Hayden RE, Paniello RC, Yeung CST, et al: Improvement of skin flap survival with calcium antagonists, in press.
19 +
Hayden RE, Paniello RC, Yeung CST, et al:  The effect of glutathione and vitamins A, C, and E on acute skin flap survival . Laryngoscope 1987;;97:1176-1179.
20 +
Sagi A, Ferder M, Leveas D, et al:  Improved survival of island flaps after prolonged ischemia by perfusion with superoxide dismutase . Plast Reconstr Surg 1986;;77:639-644.
21 +
Manson PN, Narayan KK, Im MJ, et al:  Improved survival in free skin flap transfers in rats . Surgery 1986;;99:211-214.
22 +
Finseth F, Cutting C:  An experimental neurovascular island flap for the study of the delay phenomenon . Plast Reconstr Surg 1986;; 61:412.
23 +
Sasaki GH, Pang CY:  Hemodynamics and viability of acute neurovascular island skin flaps in rats . Plast Reconstr Surg 1986;;65:152-158.
24 +
Nagy IZ, Floyd RA:  Hydroxyl free radical reactions with amino acids and proteins studied by electron spin resonance spectroscopy and spin-trapping . Biochim Biophys Acta 1984;; 790:238-250.
25 +
Floyd RA, Nagy IZ:  Formation of long-lived hydroxyl free radical adducts of proline and hydroxyproline in a Fenton reaction . Biochim Biophys Acta 1984;;790:94-97.
26 +
Pisarenko OI, Solomatina ES, Studneva IM:  The role of amino acid catabolism in the formation of the tricarboxylic acid cycle intermediates and ammonia in anoxic rat heart . Biochim Biophys Acta 1986;;885:154-161.
27 +
Romson JL, Hook BG, Kunkel SL, et al:  Reduction of the extent of ischemic myocardial injury by neutrophil depletion in the dog . Circulation 1983;;67:1016.
28 +
Mitsos SE, Askew TE, Fantone JC, et al:  Protective effects of N-2-mercaptopropionyl glycine against myocardial reperfusion injury after neutrophil depletion in the dog: Evidence for the role of intracellular-derived free radicals . Circulation 1986;;73:1077-1086.
29 +
Korthuis RJ, Granger DN, Townsley MI, et al:  The role of oxygen-derived free radicals in ischemia-induced increases in canine skeletal muscle vascular permeability . Circ Res 1985;; 57:599-609.
30 +
Dean RT, Pollak JK:  Endogenous free radical generation may influence proteolysis in mitochondria . Biochem Biophys Res Commun 1985;;126:1082-1089.
31 +
Boveris A:  Mitochondrial production of superoxide radical and hydrogen peroxide . Adv Exp Med Biol 1977;;78:67-82.
32 +
Rau EE, Shine KI, Gervais A, et al:  Enhanced mechanical recovery of anoxic and ischemic myocardium by amino acid perfusion . Am J Physiol 1979;;236:H873-879.
33 +
Wright G:  Amino acids in the treatment of ischemic heart disease . J Mol Cell Cardiol 1985;; 17:441-443.
34 +
Adams GE, Aldrich JE, Bisby RH, et al:  Selective free radical reactions with proteins and enzymes: Reactions of inorganic radical anions with amino acids . Radiat Res 1972;;49:278-289.
35 +
Land EJ, Prutz WA:  Reaction of azide radicals with amino acids and proteins . Int J Radiat Biol 1979;;36:75-83.
36 +
Tamba M, Badiello R:  Reactions of selenium dioxide free radicals with amino acids and enzymes . Int J Radiat Biol 1985;;48:259-270.
37 +
Hoey BM, Butler J:  The repair of oxidized amino acids by antioxidants . Biochim Biophys Acta 1984;;791:212-218.
38 +
Martensson J:  The effect of fasting on leukocyte and plasma glutathione and sulfur amino acid concentrations . Metabolism 1986;; 35:118-121.
39 +
Hahn R, Wendel A, Flohe L:  The fate of extracellular glutathione in the rat . Biochim Biophys Acta 1978;;539:324-337.
40 +
Sepulveda FV, Burton KA, Brown PD:  Calcium movements accompanying transport of sugar or amino acids by rabbit enterocytes . Biochim Biophys Acta 1986;;856:185-187.

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