Effects of Preconditioning With Transcutaneous Electrical Nerve Stimulation Monitored by Infrared Thermography on the Survival of Pedicled Perforator Flaps in a Rat Model

Abstract

Objective: Pedicled perforator partial or complete necrosis with a rate of 13.7%. This study was undertaken to test whether preconditioning with transcutaneous electrical nerve stimulation (TENS) monitored by infrared thermography protect against partial necrosis by converting the choke anastomoses to the true anastomoses via inducing heme oxygenase-1 (HO-1) in a rat pedicled perforator flap model. Methods: Seventy-two Sprague-Dawley rats were randomly assigned to the control, the TENS, the TENS + SnPP (tin protoporphyrin; HO-1 activity inhibitor; 50 μmol/kg) and the TENS +0.9% saline groups. On the unilateral dorsum of the rats, a rectangular flap donor site of 11 Â 3 cm was marked out, which contained three perforator angiosomes and two choke zones. On days 1, 3 and 4, 1 hour of TENS (biphasic pulses, 25 mA, 80 Hz, 200 μs) was applied to the flap donor sites, respectively. On day 5, after the flap donor sites were assessed by infrared thermography, the flaps were harvested based on the deep circumflex iliac artery perforator. Results: Infrared thermography showed that the choke zones in the flap donor sites presented white in the TENS and the TENS +0.9% saline groups, whereas they presented red in the control and the TENS + SnPP groups. Postmortem arteriography showed that the number of arterioles across each choke zone significantly increased in the TENS and the TENS +0.9% saline groups compared with the control and the TENS + SnPP groups. Immunohistochemistry and western blot showed a significant increase in HO-1 in the choke zones after TENS preconditioning. The necrotic area percentage of the flaps was significantly decreased in the TENS (4.3% ± 2.6%) and the TENS +0.9% saline groups (4.5% ± 2.3%) compared with the control (24.8% ± 5.0%) ( P < 0.001); there was no significant difference between the TENS and the TENS + SnPP (24.4% ± 7.3%) groups. Conclusions: These data show that TENS preconditioning monitored by infrared thermography might be a promising strategy to prevent pedicled perforator flaps from partial necrosis.

Heme oxygenase‐1 therapy attenuates muscle atrophy following global brachial plexus avulsion in juvenile rats

“…Future studies on the pan‐plexus injury repair rat model will be necessary to better corroborate the efficacy of HO‐1 on neuromusculoskeletal protection. Assuming that HO‐1 is capable of preserving mass and ultrastructural characteristics in denervated muscle over long periods of time in humans, muscle‐targeted upregulation of HO‐1 in a noninjurious, clinically feasible manner, such as passive heat or electrical stimulation, 38,39 may be an effective adjunct treatment to improve hand function in children with pan‐plexus injury.…”

Application of Infrared Thermography in the Rehabilitation of Patients in Veterinary Medicine

“…Therapies such as acupuncture, photo biomodulation, electrostimulation, or thermotherapy can modify the superficial thermal response associated with the inflammatory process and pain [ 22 , 23 , 24 ]. Some studies have shown that, for example, electrostimulation with transcutaneous electrical nerve stimulation (TENS) prevents tissular necrosis [ 25 ], while high-intensity laser therapy applied to racehorses with back pain has been shown to decrease the palpation score for pain [ 26 ]. Although further studies are required, these events may show a distinct thermal response when evaluated through IRT [ 27 , 28 , 29 ].…”