Comparison of Different Hemostatic Net Applications in a Rat Dorsal Skin Flap Model

Although several articles have discussed the use of hemostatic nets to close dead spaces, no in vivo experimental studies have examined simultaneously the histology and tissue perfusion of these techniques.

The aim of this study was to compare variations of the hemostatic net technique commonly used in current practice.

Two different hemostatic net suturing techniques and 2 suture removal times were tested, with a control group for comparison. In a modified McFarlane flap model, hemostatic net sutures were placed in either a vertical or horizontal pattern. Suture removal times were set at 60 hours and 7 days. Perfusion in the proximal, middle, and distal parts of the flap was assessed by SPY-assisted immunofluorescence angiography (Novadaq, Kalamazoo, MI) at 0 minutes, 60 hours, and 7 days after the first surgery. The rat dorsal flap was photographed in a standardized manner 1 week postsurgery. Flap survival areas were calculated as a percentage using ImageJ software (US National Institute of Health, Bethesda, MD). On day 20, all rats were killed and sent for histological examination.

There was no statistically significant difference in macroscopic flap survival between the groups (P > .05). Group 5 (control) was statistically different with lower neovascularization scores than the other groups in all 3 segments (P < .01).

Hemostatic nets may improve neovascularization at the flap base but do not significantly affect overall flap survival.