Calis Mert, Demirtas Tugrul Tolga, Sert Gokhan, Irmak Gulseren, Gumusderelioglu Menemse, Turkkani Ayten, Çakar Ayse Nur, Ozgur Figen
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Bioengineering Department, Hacettepe University, Ankara, Turkey.
Lasers Surg Med. 2019 Aug;51(6):538-549. doi: 10.1002/lsm.23063. Epub 2019 Feb 1.
The aim of this study was to evaluate the effect of relatively novel approach of application of polychromatic light waves on flap survival of experimental musculocutaneous flap model and to investigate efficacy of this modality as a delay procedure to increase vascularization of zone 4 of transverse rectus abdominis musculocutaneous (TRAM) flap.
Twenty-one Wistar rats were randomized and divided into 3 experimental groups (n = 7 each). In group 1 (control group), after being raised, the TRAM flap was sutured back to its bed without any further intervention. In group 2 (delay group), photobiomodulation (PBM) was applied for 7 days as a delay procedure, before elevation of the flap. In group 3 (PBM group), the TRAM flap was elevated, and PBM was administered immediately after the flap was sutured back to its bed for therapeutic purpose. PBM was applied in 48 hours interval from 10 cm. distance to the whole abdominal wall both in groups 2 and 3 for one week. After 7 days of postoperative follow-up, as the demarcation of necrosis of the skin paddle was obvious, skin flap survival was further evaluated by macroscopic, histological and microangiographic analysis.
The mean percentage of skin flap necrosis was 56.17 ± 23.68 for group 1, 30.92 ± 17.46 for group 2 and 22.73 ± 12.98 for group 3 PBM receiving groups 2 and 3 revealed less necrosis when compared to control group and this difference was statistically significant. Vascularization in zone 4 of PBM applied groups 2 and 3 was higher compared to group 1 (P = 0.001). Acute inflammation in zone 4 of group 1 was significantly higher compared to groups 2 and 3 (P = 0.025). Similarly, evaluation of zone 1 of the flaps reveled more inflammation and less vascularization among the samples of the control group (P = 0.006 and P = 0.007, respectively). Comparison of PBM receiving two groups did not demonstrate further difference in means of vascularization and inflammation density (P = 0.259).
Application of PBM in polychromatic fashion enhances skin flap survival in experimental TRAM flap model both on preoperative basis as a delay procedure or as a therapeutic approach. Lasers Surg. 51:538-549, 2019. © 2019 Wiley Periodicals, Inc.
本研究旨在评估应用多色光波这种相对新颖的方法对实验性肌皮瓣模型皮瓣存活的影响，并研究该方法作为一种延迟程序增加腹直肌横形肌皮瓣（TRAM瓣）4区血管化的疗效。
将21只Wistar大鼠随机分为3个实验组（每组n = 7）。第1组（对照组），掀起TRAM瓣后，将其缝合回原处，不进行任何进一步干预。第2组（延迟组），在掀起皮瓣前，采用光生物调节（PBM）作为延迟程序应用7天。第3组（PBM组），掀起TRAM瓣，在皮瓣缝合回原处后立即进行PBM治疗。第2组和第3组均从距整个腹壁10 cm处开始，每隔48小时进行一次PBM治疗，持续一周。术后随访7天，由于皮瓣坏死界限明显，通过宏观、组织学和微血管造影分析进一步评估皮瓣存活情况。
第1组皮瓣坏死的平均百分比为56.17±23.68，第2组为30.92±17.46，第3组为22.73±12.98。接受PBM治疗的第2组和第3组与对照组相比，坏死较少，且差异具有统计学意义。第2组和第3组应用PBM的4区血管化程度高于第1组（P = 0.001）。第1组4区的急性炎症明显高于第2组和第3组（P = 0.025）。同样，对皮瓣1区的评估显示，对照组样本中的炎症更多，血管化更少（分别为P = 0.006和P = 0.007）。接受PBM治疗的两组在血管化和炎症密度均值方面没有进一步差异（P = 0.259）。
以多色方式应用PBM可提高实验性TRAM瓣模型的皮瓣存活率，无论是术前作为延迟程序还是作为治疗方法。《激光外科学》。51:538 - 549，2019年。©2019威利期刊公司。
