EVALUATION OF CUTANEOUS FLAP SURVIVAL BY IR -THERMOGRAPHY

EVALUATION OF CUTANEOUS EVALUATION OF CUTANEOUS FLAP SURVIVAL BY FLAP SURVIVAL BY

IR -THERMOGRAPHYIR -THERMOGRAPHY

¹¹ Department of Otolaryngology - Head and Neck Surgery, University Hospital Department of Otolaryngology - Head and Neck Surgery, University Hospital »Sestre milosrdnice«, Zagreb, Croatia»Sestre milosrdnice«, Zagreb, Croatia² Faculty of Mechanical Engineering and Naval Architecture, University of ² Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, CroatiaZagreb, Zagreb, Croatia³ Department of Pharmacology and Pathology, Faculty of Medicine, Universitiy ³ Department of Pharmacology and Pathology, Faculty of Medicine, Universitiy of Zagreb, Zagreb, Croatiaof Zagreb, Zagreb, Croatia

Petar Drvis ¹, Drazen Shejbal ¹, Srecko Svaic², Ivanka Boras², Mirela Susa², Livije Kalogjera ¹, Igor Petrovic ³, Predrag Sikiric ³

Flap:Flap:

part of the tissue, part of the tissue, divided from its divided from its background, used for background, used for covering the tissue covering the tissue defect in plastic and defect in plastic and reconstructive surgeryreconstructive surgery

Flap survival:Flap survival:

““All of the flap survives, except the All of the flap survives, except the part needed to cover the defect.”part needed to cover the defect.”

Luis VasconesLuis Vascones

plenty of recent studies plenty of recent studies show the influence of show the influence of different drugs on the different drugs on the cutaneous flap survival cutaneous flap survival

Capsaicin:Capsaicin:

depletes neuropeptide transmitter content depletes neuropeptide transmitter content from primary sensory neuronsfrom primary sensory neurons

platelet disaggregation platelet disaggregation vasodilatationvasodilatation

controversal influence on flap survivalcontroversal influence on flap survival

IinumaT,SawadaY. Topical application of capsaicin and flap survival. IinumaT,SawadaY. Topical application of capsaicin and flap survival.

Br J Plast Surg 1996 Jul;49(5):319-20 Br J Plast Surg 1996 Jul;49(5):319-20

Corticosteroids:Corticosteroids:

improve venous flap survivalimprove venous flap survival

impair wound healingimpair wound healing

Saray A, Can B, Sevin K. Effects of methylprednisolone on the viability of experimental Saray A, Can B, Sevin K. Effects of methylprednisolone on the viability of experimental flow-through venous flaps. J Reconstr Microsurg 2002 Oct;18(7):615-22flow-through venous flaps. J Reconstr Microsurg 2002 Oct;18(7):615-22

Mitomycin:Mitomycin:

use in ophtalmology and ENTuse in ophtalmology and ENT

depressing wound healing depressing wound healing

Demir T, Turgut B, Akyol N, Ozercan I, Ulas F, Celiker U. Effects of amniotic membrane transplantation and mitomycin C on wound healing in experimental glaucoma surgery. Ophthalmologica 2002 Nov-Dec; 216 (6): 438-42

Gastric pentadecapeptideGastric pentadecapeptide BPC-157: BPC-157:

product of gastric mucosaproduct of gastric mucosa protective effectprotective effect improves burn wound healing and bone improves burn wound healing and bone

fracture healingfracture healing

Sikiric P, Seiwerth S, Mise M, Staresinic M, Bedekovic V, Zarkovic N, Borovic S, Gjurasin M, Boban-Blagaic A, Blagaic L, Rucman N, Anic T. Corticosteroid-impairment of healing and gastric pentadecapeptide BPC-157 cream in burned mice. Burns 2003; 29: 323-334

Study:Study:

the effects of a topically the effects of a topically applied applied capsaicin, capsaicin, methylprednisolon, methylprednisolon, mitomycinmitomycin andand gastric gastric pentadecapeptide BPC-157pentadecapeptide BPC-157

improvement of skin improvement of skin vitality and prevention of vitality and prevention of distal flap necrosis distal flap necrosis

random-pattern flap model random-pattern flap model of the ratof the rat

Methods:Methods:

50 Wistar female rats:50 Wistar female rats:4 experimental groups4 experimental groupscontrol groupcontrol group

full thickness inferiorly full thickness inferiorly based dorsal random-based dorsal random-pattern skin flap pattern skin flap raised and sutured raised and sutured back into placeback into place

gelatin sponge was gelatin sponge was placed between the placed between the flap and its recipient flap and its recipient bed, soaked with: bed, soaked with:

0.9% saline0.9% saline in the in the control group control group

capsaicin, capsaicin, methylprednisolon, methylprednisolon, mitomycinmitomycin and and BPC-BPC-157 157 in the in the experimental groups experimental groups

the flap survival was the flap survival was judged judged one weekone week postoperatively postoperatively

macroscopic and macroscopic and thermographic viewthermographic view

Vitality of the flap Vitality of the flap and survival area and survival area was measured by was measured by infrared infrared termographytermography

Eisenbeis W, Marotz J, Schrade JP. Reflection-optical multispectral imaging method for objective determination of burn depth. Burns Vol. 25, No 6, l999, p 697-704

• FLIR ThermaCAM SC2000

IR thermography:IR thermography:

non-invasive diagnostic non-invasive diagnostic method method

offers two-dimensional offers two-dimensional representation of the representation of the surface temperature of surface temperature of the skin the skin

evaluation of the evaluation of the cutaneous blood cutaneous blood circulation circulation

Koteles GJ, Benko I, Nemeth G. Use of termography in diagnosis of local radiation injuries. Health Physics, 74, 1998; p 264-265

cutanous flap evaluation cutanous flap evaluation diagnosis of radiation and burn injury diagnosis of radiation and burn injury early diagnosis of cancerearly diagnosis of cancer

Emissivity:Emissivity:

ε = 0.95ε = 0.95

Results:Results:

capsaicincapsaicin and and mitomycinmitomycin did not did not show statistically significant decrease show statistically significant decrease in skin flap necrosis in skin flap necrosis (p> 0.05) (p> 0.05)

methylprednisolonmethylprednisolon and and BPC-157BPC-157 resulted in a resulted in a statistically significant statistically significant decrease in skin flap decrease in skin flap necrosis necrosis (p< 0.05) (p< 0.05)

Test Statisticsb

,000

10,000

-2,337

,019

,029a

Mann-Whitney U

Wilcoxon W

Z

Asymp. Sig. (2-tailed)

Exact Sig. [2*(1-tailedSig.)]

ONEW

Not corrected for ties.a.

Grouping Variable: BRb.

0 10 20 30 40 50

MP

BPC

CONT

CAPS

MIT

exp

cont

0

1

2

3

4

5

6

7

8

9

MP BPC CONT CAPS MIT

cont

exp

10 20 30 40 50 60 70 80 90 100

40,1

33,2

26,2

32,1

12,2

31,0

10,6

29,9

8,7

28,9

1,4

27,8

0,4

26,7

0,3

25,7

0,1

24,6

0,0

23,5

0,0

22,5

0,0

% °C

positive correlation of macroscopic positive correlation of macroscopic and thermographic view and thermographic view (p< 0.05) (p< 0.05)

nno correlation to the inflammatoo correlation to the inflammatoyy cellscells infiltration infiltration

Conclusion:Conclusion:

the topically applied methylprednisolon and the topically applied methylprednisolon and

BPC-157 was effective in reducing ischemic BPC-157 was effective in reducing ischemic

necrosisnecrosis

prophylactic therapy for risky skin flaps in plastic prophylactic therapy for risky skin flaps in plastic and reconstructive surgeryand reconstructive surgery

Conclusion Conclusion IIII::

IR thermography is easy method for evaluation IR thermography is easy method for evaluation of the vitality and survival area of the skin flapsof the vitality and survival area of the skin flaps

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