The effects of hyperbaric oxygen therapy on the survival of dorsal random skin flap: an experimental study in streptozotocin-induced diabetic rats

ABSTRACT

There have been increasing interests of diabetes in the realm of plastic surgery due to problems like foot ulcer as a complication, delayed wound healing or higher failure rates of flap surgery. Main pathology in diabetes is microvascular compromise as well as metabolic derangements. The disturbance in microvascular circulation results in ischemic environments in the body and acts as a main factor that determines the limit of reconstructive or aesthetic plastic surgery. A useful method to overcome such problems is the use of hyperbaric oxygen therapy, which is known to be effective in the treatment of ischemic skin ulcer or osteoradionecrosis. However, there have been few studies on the survival of diabetic random skin flap or the effects of hyperbaric oxygenation directed to increase survival of such flap. In our study, we supposed that the survival of diabetic random skin flap was diminished owing to compromised microvascular pathology and blood rheology, and metabolic derangements, so we hypothesized that hyperbaric oxygen therapy has both reversible and irreversible effects on the survival of ischemic random skin flap in Streptozotocin-induced diabetic rats. Increase of local transcutaneous oxygen concentration, O2 affinity in blood and dysmorphogenesis of red blood cells are reversible and relatively short-term effects and promotion of neoangiogenesis is irreversible or long-term effects. We intended to confirm that hyperbaric rats and to compare the effects between preoperative and postoperative hyperbaric oxygenation on the survival of such flap. And we expect the additional effects of hyperbaric oxygenation on metabolism in diabetic rat, such as lowering the blood glucose level and solving the arrested weight gain. We divided Streptozotocin-induced diabetic rats into three groups the first was non-treatment diabetic group, the second was preoperative hyperbaric oxygen treated diabetic group(100% O2, 2 atm, 90min, 15sessions, twice a day), and the third was postoperative hyperbaric oxygen treated group(100% O2, 2atm, 90min, 15sessions, twice a day). After elevation of random skin flap on dorsum of diabetic rats, we evaluated the extent of flap survival by measuring the necrotic areas at 3rd, 7th, 10th, and 13th postoperative days. At that time, we intended to evaluate both effects on flap survival by preoperative and postoperative hyperbaric oxygen therapy. As a result, flap survival of non-treated diabetic group was 41% at 13th postoperative days. In diabetic groups with preoperative and postoperative hyperbaric oxygen therapy, flap survival were increased to 64.6% and 62.4% respectively. Diabetic groups with hyperbaric oxygen therapy have a tendency of meaningful decrement in blood glucose level. However, there were no meaningful differences between preoperative and postoperative hyperbaric oxygen therapy. Hyperbaric oxygen therapy has no effective correlations with body weight changes. We conclude that hyperbaric oxygen therapy has some useful effects on the survival of diabetic random skin flap.