Leukocyte behavior in a free-flap model following chemotherapy and application of granulocyte colony-stimulating factor (GCSF)

Free-flap reconstruction following tumor resection and chemotherapy is used increasingly in sarcoma patients. Granulocyte colony-stimulating factor (GCSF) is used to stimulate polymorphnuclear leukocytes (PMNs). In this study we used a free-flap model to investigate PMN behavior after chemotherapy and GCSF stimulation. Eighteen Lewis rats were divided into three groups: (1) chemotherapy + vehicle; (2) chemotherapy + GCSF; and (3) control. Group 1 received vinblastine; group 2 received vinblastine plus 300 microg rhGCSF. Blood was drawn for total white cell and PMN counts for 9 days. Free-flap surgery was simulated by isolating the cremaster muscle on its pedicle and anastomosing the artery. Leukocyte-endothelium interaction was assessed by observation of leukocytes rolling and sticking. Leukocyte sequestration was measured by counting leukocytes in the lungs and the abdomen. We found that leukocyte rolling and sticking were significantly increased, while sequestration was decreased in the chemotherapy + GCSF group. We conclude that leukocytes-endothelium interaction after chemotherapy and GCSF administration is increased in the microcirculation. This augments the risk of microvascular compromise and subsequent flap failure, as capillary flow may be altered.