Sodium hydrogen sulfide enhances microcirculation and survival in random-pattern skin flaps: An experimental rat study
- 1Istanbul Medeniyet University, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Turkey
- 2Istanbul Aydın University, Department of Histology and Embryology, Faculty of Medicine, Turkey
- 3Experimental Animal Application and Research Center, Maltepe University, Turkey
Abstract
Objectives: Random-pattern skin flaps remain vulnerable to distal ischemia and partial necrosis despite surgical refinements. Hydrogen sulfide (H₂S) is an endogenous gasotransmitter with cytoprotective and proangiogenic properties. This study evaluated the effects of sodium hydrogen sulfide (NaHS) on flap viability, microvascular perfusion, and histological outcomes in a rat dorsal random-pattern skin flap model.
Methods: Twenty-one male Sprague–Dawley rats were randomized into control, sham, and NaHS groups (n = 7 each). NaHS (200 µg/kg/day) was administered intraperitoneally for 15 days prior to flap elevation. A 9 × 3 cm caudally based dorsal flap was created using the McFarlane model. On postoperative day 7, perfusion was objectively assessed using indocyanine green fluorescence angiography. Inflammation, re-epithelialization, vascularization, and collagen organization were assessed using semi-quantitative scoring, whereas the apoptotic index was determined quantitatively based on TUNEL-positive cell counts.
Results: NaHS significantly increased viable flap area and reduced distal necrosis compared with control and sham groups. Fluorescence imaging demonstrated enhanced distal perfusion and a denser microvascular network in the NaHS group. Histologically, NaHS promoted complete re-epithelialization, organized collagen structure, and markedly increased vascularization (p < 0.01), while significantly decreasing inflammation and apoptosis (p < 0.001).
Conclusions: Sodium hydrogen sulfide improved random-pattern skin flap viability by enhancing microvascular perfusion and attenuating ischemia-induced inflammation and apoptosis. These findings suggest that H₂S donors may represent a potential pharmacologic approach to improve ischemic flap survival in reconstructive surgery.
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BibTeX
@article{onal2026sodium,
title = {{Sodium hydrogen sulfide enhances microcirculation and survival in random-pattern skin flaps: An experimental rat study}},
author = {Mustafa Onal and Aysun Ozbay Onal and Mehmet Goktug Esmer and Oguz Kaan Tombul and Merdan Serin},
journal = {JPRAS open},
year = {2026},
month = oct,
doi = {10.1016/j.jpra.2026.10.005},
url = {https://europepmc.org/article/PMC/PMC13721927},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sodium hydrogen sulfide enhances microcirculation and survival in random-pattern skin flaps: An experimental rat study
AU - Mustafa Onal
AU - Aysun Ozbay Onal
AU - Mehmet Goktug Esmer
AU - Oguz Kaan Tombul
AU - Merdan Serin
PY - 2026
DA - 2026/10/22
JO - JPRAS open
DO - 10.1016/j.jpra.2026.10.005
UR - https://europepmc.org/article/PMC/PMC13721927
AB - Objectives: Random-pattern skin flaps remain vulnerable to distal ischemia and partial necrosis despite surgical refinements. Hydrogen sulfide (H₂S) is an endogenous gasotransmitter with cytoprotective and proangiogenic properties. This study evaluated the effects of sodium hydrogen sulfide (NaHS) on flap viability, microvascular perfusion, and histological outcomes in a rat dorsal random-pattern skin flap model. Methods: Twenty-one male Sprague–Dawley rats were randomized into control, sham, and NaHS groups (n = 7 each). NaHS (200 µg/kg/day) was administered intraperitoneally for 15 days prior to flap elevation. A 9 × 3 cm caudally based dorsal flap was created using the McFarlane model. On postoperative day 7, perfusion was objectively assessed using indocyanine green fluorescence angiography. Inflammation, re-epithelialization, vascularization, and collagen organization were assessed using semi-quantitative scoring, whereas the apoptotic index was determined quantitatively based on TUNEL-positive cell counts. Results: NaHS significantly increased viable flap area and reduced distal necrosis compared with control and sham groups. Fluorescence imaging demonstrated enhanced distal perfusion and a denser microvascular network in the NaHS group. Histologically, NaHS promoted complete re-epithelialization, organized collagen structure, and markedly increased vascularization (p < 0.01), while significantly decreasing inflammation and apoptosis (p < 0.001). Conclusions: Sodium hydrogen sulfide improved random-pattern skin flap viability by enhancing microvascular perfusion and attenuating ischemia-induced inflammation and apoptosis. These findings suggest that H₂S donors may represent a potential pharmacologic approach to improve ischemic flap survival in reconstructive surgery.
SN - 2352-5878
ER -