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The Effect of Contact Cooling on Ischemia in Random Pattern Cutaneous Flaps
Edward Nahabet, Hooman Riazi, Emily Wirtz, Mark Asirwatham, Donald J. Harvey, Davood Varghai, Bahman Guyuron
University Hospitals, Case Medical Center
2015-03-14
Presenter: Edward Nahabet
Affidavit:
The work regarding this project is the original work of the submitting author. The idea for the project originated from a faculty member, however Edward played a major role in the acquisition of the data, and the analysis and interpretation of the data. He drafted the abstract and received revision from other authors.
Director Name: Hooman Soltanian
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Purpose
Cooling after surgery reduces pain, swelling and ecchymosis. However, the fear of potential adverse effects of vasoconstriction caused by cooling may prevent its use when the skin is undermined extensively, for example, after rhytidectomy. The purpose of this study was to evaluate the effect of post-operative local cooling on random pattern skin flaps.
Methods
Twenty-eight random pattern skin flaps (4 x 10 cm) were raised on 4 pigs. Flaps were divided into 3 groups: control, intermittently cooled and continuously cooled. Cooling pads connected to a ThermaZone cooling device delivered local hypothermia in the range of 4 to 6 °C for 24 hours post-operatively. Flaps were photographed and harvested for histology on post-operative day 7. ImageJ Software was used to calculate the area of necrosis on each flap, confirmed with histological analysis.
Results
The control, intermittent and continuously cooled groups had an average area of necrosis of 17.61, 15.65 and 14.16 cm2, respectively. A paired comparison of mirror-image continuously cooled and control flaps on each flank of each pig, to account for differences among pigs and location of flaps, revealed significantly less area of necrosis in the continuously cooled flaps in comparison to control flaps (13.52 vs 18.94 cm2; p = 0.048).
Conclusions
Post-operative contact cooling did not reveal increased necrosis, in fact, it resulted in significantly decreased area of necrosis of random pattern skin flaps in our porcine model when continuous cooling was utilized.
