The Effect of Hyperbaric Oxygen on Reperfusion of Ischemic Axial Skin Flaps: A Laser Doppler Analysis

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Abstract
This study evaluates the microvascular reperfusion of ischemic skin flaps with and without acute hyperbolic oxygen (HBO) treatment. Thirty-two axial pattern epigastric skin flaps (3 x 6 cm) in male Wistar rats were subjected to 8 hours of global ischemia by pedicle clamp occlusion. The rats were divided into the following control and two experimental groups: Control (n = 12) with ischemia, no HBO; Group 1 (n = 11) with HBO treatment (three 1.75-hour dives, 2.5 absolute atm, 100% O2) during ischemia; and Group 2(n = 9) with HBO treatment (two 1.75-hour dives) immediately after ischemia. Laser Doppler flows were recorded in two distal standardized flap locations at 0.5, 2, 4, and 18 hours after reperfusion in control rats and Group 1 rats and at 18 hours only in Group 2 rats, using a Med-Pacific 6000 laser Doppler unit. Mean distal flap laser Doppler flows (mV) were Control: 0.5 hours=23.2 ± 11.9, 2 hours=52.8 ± 27.3,4hours=53.6 ± 32.1,18hours=40.2 ± 36.2; Group 1: 0.5 hours=71.8 ± 30.9 (p<0.05 vs. control), 2 hours=74.3 ± 27.3, 4 hours=67.4 ± 20.6, 18 hours=79.1 ± 40.3 (p<0.05 vs. control); and Group 2:18 hours=90.3 ± 47.9 (p<0.05 vs. control). It is concluded that acute HBO treatment of ischemic rat skin flaps improves distal microvascular perfusion as measured by laser Doppler flowmetry. This effect is observed for HBO treatment given either during or immediately after prolonged global ischemia. Although the mechanism of this beneficial effect on the microcirculation remains unknown, these results correlate with earlier findings that HBO treatment improves survival of rat axial skin flaps subjected to prolonged global ischemia.

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