Photobiomodulation with polychromatic light increases zone 4 survival of transverse rectus abdominis musculocutaneous flap

Abstract

Objective The aim of this study was to evaluate the effect of relatively novel approach of application of polychromatic light waves on flap survival of experimental musculocutaneous flap model and to investigate efficacy of this modality as a delay procedure to increase vascularization of zone 4 of transverse rectus abdominis musculocutaneous (TRAM) flap. Methods Twenty‐one Wistar rats were randomized and divided into 3 experimental groups (n = 7 each). In group 1 (control group), after being raised, the TRAM flap was sutured back to its bed without any further intervention. In group 2 (delay group), photobiomodulation (PBM) was applied for 7 days as a delay procedure, before elevation of the flap. In group 3 (PBM group), the TRAM flap was elevated, and PBM was administered immediately after the flap was sutured back to its bed for therapeutic purpose. PBM was applied in 48 hours interval from 10 cm. distance to the whole abdominal wall both in groups 2 and 3 for one week. After 7 days of postoperative follow‐up, as the demarcation of necrosis of the skin paddle was obvious, skin flap survival was further evaluated by macroscopic, histological and microangiographic analysis. Results The mean percentage of skin flap necrosis was 56.17 ± 23.68 for group 1, 30.92 ± 17.46 for group 2 and 22.73 ± 12.98 for group 3 PBM receiving groups 2 and 3 revealed less necrosis when compared to control group and this difference was statistically significant. Vascularization in zone 4 of PBM applied groups 2 and 3 was higher compared to group 1 (P = 0.001). Acute inflammation in zone 4 of group 1 was significantly higher compared to groups 2 and 3 (P = 0.025). Similarly, evaluation of zone 1 of the flaps reveled more inflammation and less vascularization among the samples of the control group (P = 0.006 and P = 0.007, respectively). Comparison of PBM receiving two groups did not demonstrate further difference in means of vascularization and inflammation density (P = 0.259). Conclusion Application of PBM in polychromatic fashion enhances skin flap survival in experimental TRAM flap model both on preoperative basis as a delay procedure or as a therapeutic approach. Lasers Surg. 51:538–549, 2019. © 2019 Wiley Periodicals, Inc.

Photobiomodulation with polychromatic light (600–1200 nm) improves fat graft survival by increasing adipocyte viability, neovascularization, and reducing inflammation in a rat model

“…28 Increased neovascularization in experimental skin-muscle flap has been demonstrated by the authors previously. 11 In accordance…”

“…Castro et al found improved integration and viability of the skin grafts in rats when exposed to laser PBM at 660 nm, 40 mW, 60 s, 2.4 J for 7 days 44 . Calis et al reported improved survival of zone 4 skin in transverse rectus abdominis myocutaneous flap model in rats when polychromatic light PBM at 600–1200 nm for 12 min was applied for 7 days in 48 h intervals 11 . However, literature data lacks information about photobiomodulation modalities and their influence on fat grafting procedure.…”

“…44 T A B L E 3 Scores of the groups following histological evaluation Calis et al reported improved survival of zone 4 skin in transverse rectus abdominis myocutaneous flap model in rats when polychromatic light PBM at 600-1200 nm for 12 min was applied for 7 days in 48 h intervals. 11 However, literature data lacks information about photobiomodulation modalities and their influence on fat grafting procedure. Several experimental studies have been conducted for recipient site preconditioning in search for improved fat graft survival, including administration of deferoxamine, VEGF, epidermal growth factor, erythropoietin, nacetylcysteine.…”

“…Photobiomodulation (PBM) as a general term defines the modalities of application of light energy via low‐level lasers, light‐emitting diode light sources, laser and polychromatic light sources with different wavelengths and energy densities. There is a growing body of evidence that PBM triggers cellular response over mitochondrial cytochrome oxidase c, thus increases energy metabolism, promotes wound healing over its effects on keratinocytes, fibroblasts, neutrophils, macrophages, mast cells, collagen synthesis, stimulates neovascularization, and angiogenesis, in relation with its anti‐inflammatory properties, and improves overall cellular viability of full‐thickness skin grafts, skin‐muscle flaps, keratinocytes, and osteoblasts 3–11 …”

“…There is a growing body of evidence that PBM triggers cellular response over mitochondrial cytochrome oxidase c, thus increases energy metabolism, promotes wound healing over its effects on keratinocytes, fibroblasts, neutrophils, macrophages, mast cells, collagen synthesis, stimulates neovascularization, and angiogenesis, in relation with its anti-inflammatory properties, and improves overall cellular viability of fullthickness skin grafts, skin-muscle flaps, keratinocytes, and osteoblasts. [3][4][5][6][7][8][9][10][11] The survival of transplanted fat depends on numerous factors, however, the most determinant factors are recipient site vascularization and viability of transferred adipocytes. 12 Viability of transferred fat can be enhanced by application of polychromatic light, which improves both neovascularization capacity of the graft and the recipient site.…”