Commentary on: Preoperative shockwave treatment enhances ischemic tissue survival in a rat flap model

Abstract

1743-9191/$ e see front matter 2011 Surgical Asso doi:10.1016/j.ijsu.2011.06.001 Skin flaps are a vital tool in plastic surgery and used to treat and manage a variety of conditions. However, necrosis of distal flap regions continue to have a high prevalence and often lead to postsurgical complications such as infection and the need for repeat surgery. Extracorporeal shock wave therapy (ESWT) has a range of functions in medicine including lithotripsy in the field of urology and for the treatment of musculoskeletal disorders.1 The potential role of ESWT in improving skin flap survival has now been explored by several studies in animal models.2e10 Meirer and colleagues were the first to indicate a use for ESWT in the maintenance of skin flap viability. Epigastric skin flaps were raised on Wistar rats with application of ESWT immediately postsurgery.2 This was shown to significantly reduce the total necrotic zones found compared with the control group. Similarly there was an increase in VEGF expression within this study. Recently, Keil et al. showed preoperative exposure of the flap segment to ESWT was successful in increasing tissue survival.3 A single ESWT exposure, seven days prior to flap retrieval increased the area of surviving tissue compared with the control group; this builds on the results of a previous study.4 Direct visualisation of increased micro-vessel density was observed following ESWT, this was associated with a rise in VEGF to total protein ratio within the flap. Both these markers indicate an increased likelihood of flap survival.3 This increase in vascular density may open a potential therapeutic avenue for ESWT in the treatment of vascular conditions for example associated with Diabetes Mellitus.12 This technique has been further expanded by the work examining the use of repeated ESWT on skin flaps both concomitantly