Effects of hyperbaric oxygen and N-acetylcysteine in survival of random pattern skin flaps in rats

Abstract

Objective:Our aim is to investigate the role of HBO (hyperbaric oxygen), NAC (N-acetylcysteine), and HBO plus NAC on the necrosis area of random rat's skin flaps of a modified McFarlane flap design.Materials and Methods:Thirty-two male Wistar rats were randomly divided into four groups: G-S (sham: n = 8), G-NAC (NAC: n = 8), G-HBO (HBO: n = 8), and G-HN (HBO plus NAC: n = 8). A rectangular skin flap (2 × 8 cm2) was dissected from the muscular dorsal layer, preserving the cranial pedicle. Polyethylene film was placed over the muscular layer and an interrupted 3.0 nylon suture was employed to fix the flap into the original place. On the eighth day, full-thickness biopsy samples (2 × 1 cm2) were collected from the proximal, middle, and cranial areas of the skin flap, and in a site away from the flap labelled as the control area.Results:The measurements of necrotic areas in the groups were 18.3% in G-S, 24.3% in G-NAC, 12.6% in G-HBO, and 14.9% in G-HN. Significant difference was observed between the groups G-HBO and G-HN as well as G-NAC.Conclusion:HBO is associated with reduced area of necrosis of skin flap. The G-NAC group was associated with poor results when examined in isolation. The association between HBO and NAC did not produce favourable results with respect to the use of HBO alone. These findings suggest that the diffusion of oxygen through the interstitial space was the determining factor of more favourable results of HBO.

Transdermal application of azithromycin-amlodipine-heparin gel enhances survival of infected random ischaemic flap

“…Neutrophil infiltration after ischaemia has been demonstrated in different animal models of skin flaps [22,23]. In the present study, using H&E staining we observed that in flaps that were not treated or treated with the gel base there was widespread infiltration of inflammatory cells, degeneration, and necrosis of flap tissue (Figures 3b, c, f, and h).…”

Action of hyperbaric oxygenation in the rat skin flap

“…It should be mentioned, that all regions presented attenuation of histopathological changes with the application of HBO. Despite the beneficial effects of the treatment of wounds or skin flaps with HBO have been well described [14][15] , early studies did not emphasize detailed regions as did in our study.…”

“…It is believed that the HBO angiogenesis properties are due to increased oxygen tension that may persist for several hours after HBO 14,21 . However, some authors suggest that the high rate of oxygen increases the production of free radicals, which could increase necrosis 15 , whereas others suggest that treatment with HBO causes peripheral arteriolar vasoconstriction 19 .…”

“…Rocha et al 3 noted that HBO is related to the decrease in the area of necrosis in skin wounds. In addition, the expression of VEGF in the flaps showed no significant differences between the study groups, suggesting that oxygen diffusion through the interstitial space (HBO) may be a factor in the decrease of …”

Microbial‐Enabled Photosynthetic Oxygenation for Disease Treatment

“…[176] With the continuous indepth research on the mechanism of wound repair, it is found that oxygen plays an extremely important role in wound healing, such as inflammatory response, cell proliferation, angiogenesis, collagen synthesis, and other processes must have the participation of oxygen. [177] In recent years, there has been an increasing number of studies on oxygen as an adjunct therapy for chronic wounds. The clinical use of oxygen to promote wound healing began in the early 1960s, mainly using systemic HBO (2-3 atmospheres) to treat wounds, [178] but the cost of HBO is high, and there are many contraindications and adverse reactions.…”