Effect of local application of transcutaneous carbon dioxide on survival of random pattern skin flaps

Publication date: Available online 28 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Izumi Saito, Takumi Hasegawa, Takeshi Ueha, Daisuke Takeda, Eiji Iwata, Satomi Arimoto, Akiko Sakakibara, Masaya Akashi, Shunsuke Sakakibara, Yoshitada Sakai, Hiroto Terashi, Takahide Komori
IntroductionSkin flap procedures are widely used to reconstruct skin and soft tissue defects. Skin flap necrosis is a serious postoperative complication. Many researchers have introduced pharmacological agents to improve flap ischemia in experimental studies. However, these outcomes remain controversial. We previously demonstrated that transcutaneous CO2 application improves hypoxia in fracture repair. In this study, we hypothesized that improving hypoxia by transcutaneous CO2 application can improve the blood flow of skin flaps and increase angiogenesis. We investigated whether transcutaneous CO2 application can increase the survival of random pattern skin flaps.Materials and MethodsSix-week-old male Sprague–Dawley rats were divided into two equal groups: the control group (n=6) and CO2 group (n=6). A random pattern skin flap was performed. Topical CO2 was applied by means of a hydrogel every day for 5 days in the CO2 group. The flap survival area was measured on postoperative days 1, 3, and 5. The vessel density and expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and hypoxia-inducible factor-1α (HIF-1α) were evaluated on postoperative day 5.ResultsA statistically significant difference was found in the percentage of the flap survival area between the two groups on postoperative days 3 and 5 (p<0.05). Furthermore, the expression of VEGF and bFGF was significantly higher and that of HIF-1α was significantly lower in the CO2 than control group (p<0.05).ConclusionsTranscutaneous CO2 application can improve the blood flow of skin flaps and increase angiogenesis, thus increasing the survival of random pattern skin flaps.