Contact Cooling of Random-Pattern Cutaneous Flaps: Does it Increase Necrosis?

Area of Science:

• Plastic Surgery
• Wound Healing
• Tissue Engineering

Background:

• Postoperative cooling effectively reduces pain, swelling, and bruising.
• Concerns about vasoconstriction-induced adverse effects limit cooling use in extensive skin undermining, such as after rhytidectomy.
• This study investigates the impact of cooling on skin flap necrosis.

Purpose of the Study:

• To determine if contact cooling of random-pattern skin flaps increases necrosis.
• To evaluate the safety of postoperative cooling in compromised skin flaps.

Main Methods:

• Twenty-eight random-pattern skin flaps in pigs were divided into control, intermittent cooling, and continuous cooling groups.
• Local hypothermia (4-6°C) was applied for 24 hours postoperatively using a ThermaZone device.
• Necrosis area was quantified using ImageJ software and confirmed histologically on postoperative day 7.

Main Results:

• Average necrosis areas were: control (17.61 cm²), intermittent cooling (15.65 cm²), and continuous cooling (14.16 cm²).
• No statistically significant differences in necrosis area were found between the groups (p=0.35).
• A trend suggested reduced necrosis with increased cooling duration.

Conclusions:

• Postoperative cooling, whether continuous or intermittent, does not elevate necrosis in random-pattern skin flaps.
• The findings indicate that cooling is safe for these flaps and may potentially improve outcomes.
• Further research could explore optimal cooling parameters for enhanced flap survival.