Evaluation of cutaneous flap survival by IR thermography

Abstract

There are plenty of recent studies showing the influence of different drugs on the survival of the cutaneous flap. The effects of a topically applied capsaicin, methylprednisolon, mitomycin and gastric pentadecapeptide BPC-157 in improving skin vitality and preventing distal flap necrosis were tested in a random-pattern dorsal skin flap model. Wistar rats were randomized into five groups, four experimental groups and a control group. A standardized full thickness dorsal random-pattern skin flap was raised on each rat and sutured back into place. A gelatin sponge was placed before suturing between the flap and its recipient bed, with 0.9% saline in the control group and with capsaicin, methylprednisolon, mitomycin and pentadecapeptide BPC-157 in the experimental groups. The flap survival was judged one week postoperatively, and the extent of skin flap survival was compared between the experimental groups and control. Vitality of the flap and survival area was measured by infrared termography (Fig.1). Infrared termography is non-invasive diagnostic method which offers two-dimensional representation of the surface temperature of the skin (Fig.2). It is useful for the evaluation of cutaneous blood circulation of the skin and superficial temperature can be an indicator for the vitality of the skin flap. The topically applied methylprednisolon and pentadecapeptide BPC-157 resulted in a statistically significant decrease in skin flap necrosis, compared with the control group (p< 0.05), topically applied capsaicin and mitomycin did not show statistically significant decrease in skin flap necrosis. The topically applied methylprednisolon and pentadecapeptide BPC-157 was effective in reducing ischemic necrosis in failing random-pattern skin flaps in this rat model. The results of this study suggest that such a topical drug application might have significant effects in the reduction of ischemic necrosis in the distal parts of skin flaps, and this treatment might also have applications as prophylactic therapy for risky skin flaps. Thermography of the skin is an easy method for estimating the vitality and survival area of the skin flaps.