Optimisation of the blood supply at the flap donor site through the application of cutaneous negative pressure

Abstract

At present, perforator flaps are a very popular technique in reconstructive surgery. However, in spite of the fact that perforator flaps provide favourable aesthetic results, their use is often related to complications in the form of transplanted tissue perfusion disorders.

Objective —  to investigate the possibility of optimising the blood supply at the flap donor site through the application of cutaneous negative pressure (NP).

Materials and methods. The study was carried out from 2019 to 2021. A single‑arm clinical trial consisted of 20 individuals who presented with deep wound defects requiring flap coverage. A dynamic thermography study was conducted to examine the chosen donor site before and after dressing with NP.

Results. The temperature measurements obtained from the two selected warm perforator points and the point in the cool area between perforators prior to the application of NP showed a steady downward trend in temperature. Specifically, the temperature in the cool area was observed to be lower by an average of –1.89 °С and –2.12 °С as compared to warm points. The application of local NP had an impact on trend analysis of skin temperature, which demonstrated a significant decrease in the differences between values seen in the cool and warm areas. This effect was already noted after the first day of the NP system application, as evidenced by the everyday data collection. The «levelling» of temperature curves was associated with temperature rises both in the cool area and at the perforator exit points.

Conclusions. The findings obtained from thermography analysis suggest that the application of NP has the potential to enhance blood circulation in the intended donor area. Therefore, it is plausible to discuss the possibility of improved microcirculation in the skin and the beneficial effect of local cutaneous NP application on the state of anastomoses between perforators.