Flap Preconditioning by Electrical Stimulation as an Alternative to Surgical Delay Experimental Study

Partial flap failures are unpredictable complications of reconstructive surgery. Electrical stimulation increases blood flow, capillary density, angiogenesis and vascular endothelial growth factor, anti-inflammatory effects while decreasing oxygen tension in tissues. In this study, we investigated these effective properties of electrical stimulation preoperatively on flap surgery instead of the surgical delay procedure. Modified McFarlane flaps were raised on the backs of 50 Sprague-Dawley rats. In the control group, a skin flap was made and flap survival rate was assessed on the seventh day. In the surgical delay group, 14 days after creating the bipedicled flap, the flap was totally elevated and flap survival rate was assessed on the 21st day. In the preconditioning by electrical stimulation group, the flap was created after application of electrical stimulation for 7 days. Flap survival rate was assessed on the 14th day. In the electrically stimulated ischemic flap group, the flap was created and afterward, electrical stimulation was applied for 7 days. After that, flap survival rate was assessed on the seventh day. In the surgical delay plus electrical stimulation group, following the elevation and suturing of the bipedicled flap back into its bed, electrical stimulation was applied in the first 7 days of delay, the flap was created on the 14th day, and then flap survival rate was assessed on the 21st day. In all groups, blood flow was evaluated at particular times. After completing these procedures, the flap vascularities of 5 animals from each group were assessed with microangiography. The flap survival rate of the preconditioning by electrical stimulation group was significantly higher than those of the other groups (P < 0.05). According to the blood flow estimates, except the preconditioning by electrical stimulation group and surgical delay plus electrical stimulation group, blood flow decreased in all the other groups after the postprocedure. In the microangiographic assessment of the preconditioning by electrical stimulation group, there were thin but numerous networks like vascular structures. Electrical stimulation applied to the normal area before flap elevation increased the flap survival. This increase is paramount to surgical delay which is, so far, widely known as the most effective method of improving flap vascularity.