Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Effect of Low Energy Laser on Skin Flap Survival: A Study in Murine Dorsal Skin Flap Model
Dhaval Bhavsar, MBBS1, Mayer Tenenhaus, MD FACS2.
1University of Kansas Medical Center, Kansas City, KS, USA, 2University of California San Diego, School of Medicine, San Diego, CA, USA.

Introduction: Random pattern skin flaps are commonly employed in reconstructive surgery. Despite general dimensional design guidelines, distal flap necrosis occurs with some regularity. The application of Low energy LASER (LEL) at 635 nm has been shown to augment mitochondrial activity and ATP production. We studied effects of LEL on tissue perfusion, tissue survival and cytokine response in a murine skin flap model. Materials and Methods: A caudally based skin flap, 1.5 cm x 4 cm was designed over the dorsum of mice (n=28). Study group (n=14) received 635 nm Laser irradiation, 2 min. every day for up to 4 days, beginning immediately after surgery. Control group (n=14) did not receive LEL treatment. All other care was identical. Six animals in each group were sacrificed 24 hrs after surgery to obtain tissue samples for TNF-alpha. Laser Doppler measurements were performed immediately before and after surgery and on post-operative days 1, 4, and 7 for rest of the 8 animals in both groups. These animals were euthanized on day 7 and digital photos of flaps were taken. Flap necrosis was calculated with image analysis software. Six animals received anesthesia but did undergo surgery and served as SHAM subjects for skin biopsy for TNF-alpha levels. Results: The mean flap loss in control and study animals was 54.6% and 23.7% respectively (P<0.01, ANOVA). The mean TNF-alpha levels for control and study groups were 11.72 and 1.92 (p=0.014, t-test) fold higher respectively when compared to SHAM animals. Animals in both groups demonstrated uniform pattern of increased perfusion and vasodilatation at the base of the flap peaking on day 4 but study groups showing significantly less vasodilatation. Study animals demonstrated higher tissue perfusion at the distal end of the flap compared to control animals after day 1 lasting through day 7. Conclusion: LEL improved flap survival in this murine dorsal skin flap model. Study animals demonstrated improved tissue survival and perfusion at the distal end in presence of less vasodilatation at the base and reduced inflammatory response. We plan to study the metabolic effects of LEL on tissues in ischemic and hypoxic environment.


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