Abstract: Preconditioning by Pressure Controlled Cupping Enhances Survival of Random Flap in Rat Model (Plastic Surgery 2015)

Saturday, October 17, 2015: 8:30 AM

Sung Woo Park, MD , Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea

Tae Suk Oh, MD, PhD , Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea

Jong-Woo Choi, MD, PhD, MMM , Plastic Surgery, Seoul Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea

Kyung S. Koh, MD, PhD , Plastic Surgery, Asan Medical Center, Seoul, South Korea

Presentation PDF file

Negative pressure preconditioning enhances survival of random flap in rat model.

ABSTRACT

Flap survival is essential for the success of soft tissue reconstruction, and surgical and medical methods aimed to increase flap survival have been previously introduced. Because flap viability is affected by the innate vascular supply, traditional methods mainly target vasodilatation or vascular reorientation to increase blood flow to the tissue. Because external stress induces vascular remodeling and cellular proliferation, mechanical stress caused by negative pressure is used in wound healing or tissue expansion. In this study, we used a rat random flap model to study the effectiveness of a preconditioned externally applicable device at the flap site through which negative pressure was delivered. Flap surgery was performed after preconditioning for 30 minutes every 5 days, followed by 9 days of postoperative observation. Flap survival was assessed as the area of viable tissue compared to a control group.The results showed 19.03±7.6% improved viability of the flap following negative pressure preconditioning. Tissue perfusion was increased by 24.23±20.38%, and histologic analysis of H&E, CD31 and Masson-Trichrome staining showed increased vascular density in the subdermal plexus and more organized collagen production with hypertrophy of attached muscle. Our data suggests that externally delivered negative pressure induces vascular remodeling, which leads to increased tissue perfusion and enhances flap survival.

Figure 1.

Experimental model of preconditioning with an external negative pressure chamber

Figure 2.

(A) Perfusion analysis using laser doppler flow analysis at postoperative day 9 and before and after the preconditioning. (B) Figure show increased perfusion at the distal flap after the preconditioning. (C) An increased in tissue perfusion by 24.23±20.38% was observed in the preconditioned group compared to the control group, as shown by image analysis quantification (p<0.01).

27504 Preconditioning by Pressure Controlled Cupping Enhances Survival of Random Flap in Rat Model