Laser flap delay: comparison of Erbium:YAG and CO2 lasers

The delay phenomenon has long been recognized as a powerful tool in reconstructive surgery. This phenomenon involves creating alterations in skin flap blood supply or microcirculation to increase the size of the surviving flap. In the past many reconstructive surgeons depended on surgical delay as an integral part of their surgical planning. Today surgical delay remains a reliable method for maximizing flap survival. Although surgical delay remains the gold standard many have searched for methods to create the same effect with less morbidity and reduced cost. The purpose of this study was to determine whether near-scarless delay can be performed with either the Erbium:YAG or CO2 laser using a standard McFarlane skin flap model. Four groups were identified. Surgical delay, Erbium laser delay, and CO2 laser delay groups were each compared with a nondelayed control. Each group consisted of ten Sprague-Dawley rats. On Day 0 all delay procedures were performed on the lateral periphery of the outlined dorsal skin flaps. Interruption of this lateral blood supply was accomplished by two parallel 10-cm incisions in the surgical delay group. Likewise blood supply and microcirculatory alterations were accomplished in the laser delay groups by two parallel 10-cm laser treatments. On Day 7 a 10 x 4-cm cranially based dorsal skin flap was elevated. On Day 14 flap survival was analyzed by calculating percentage flap survival. The Erbium:YAG laser delay of the McFarlane flaps resulted in an average of 32 per cent less flap loss compared with controls (P = 0.0001). The CO2 laser resulted in an average of 36 per cent less flap loss compared with controls (P = 0.0002), whereas the surgical delay group had a 23 per cent smaller flap loss (P = 0.009). There was no significant difference between any of the delay groups. These results indicated that CO2 and Erbium:YAG lasers are as effective as surgery for delay of skin flaps in the rat model. They may provide an effective and inexpensive method for near-scarless skin flap delay in humans.