The aim of this study was to determine the role of transcutaneous electrical nerve stimulation (TENS) in the viability of random skin flaps. In 30 Wistar-EPM rats, a random 10×4 cm skin flap was raised and a plastic barrier was interposed between the flap and its bed. Immediately after surgery and for two subsequent days, the rats in group 1 (the control group) were anesthetized for 1 h with the electrodes positioned in the base of the flap and without the administration of the electric stimulus. The rats in group 2 (the treatment group) were submitted to TENS for 1 h immediately after the surgery and for two subsequent days.
The percentage of necrotic area (averages of 43.11% in the rats in group 1 and 23.52% in the rats in group 2) was calculated on the seventh postoperative day in both groups.
Statistical analysis proved that TENS was more efficient in increasing random skin flap viability than was the method used in the control group.
DavisE.R., WachholzJ.H., JassirD., PerlynC.A., AgramaM.H.. Comparison of topical anti-ischemic agents in salvage of failing random-pattern skin flaps in rats.Arch Facial Plast Surg1991; 1: 27–32.
4.
JurellG., JonssonC.E.. Increased survival of experimental skin flaps in rats following treatment with antiadrenergic drugs.J Plast Reconstr Surg1976; 10: 169–72.
KjartanssonJ., LundebergT., SamuelsonU.E., DalsgaardJ., HedénP.. Calcitonin gene-related peptide (CGRP) and transcutaneous electrical nerve stimulation (TENS) increase cutaneous blood flow in a musculocutaneous flap in the rat.Acta Physiol Scand1988; 134: 89–94.
8.
LundebergT., KjartanssonJ.. Effect of electrical nerve stimulation on healing of ischemic skin flaps.Lancet1988; 24: 712–4.
9.
GherardiniG., LundebergT., CuiJ., ErikssonS.V., TrubekS., LinderothB.. Spinal cord stimulation improves survival in ischemic skin flaps: An experimental study of the possible mediation by calcitonin gene-related peptide.Plast Reconstr Surg1999; 103: 1221–8.
10.
UglandO.. Flaps and flap necrosis.Acta Chir Scand1966; 131: 408–12.
11.
DuarteI.S., GomesH.F., FerreiraL.M.. Effect of dimethyl sulphoxide on necrosis of skin flaps in rats.Can J Plast Surg1998; 6: 93–7.
12.
ABLA, LEF.. Efeito da N-Acetil-L-Cisteína sobre a necrose dos retalhos cutâneos, em ratos.São Paulo: Tese Mestrado Escola Paulista de Medicina, 1997.
13.
JansenG., LundebergT., SamuelsonU.E., ThomasM.. Increased survival of ischemic musculocutaneous flaps in rats after acupuncture.Acta Physiol Scand1989; 135: 555–8.
14.
NiinaY, IkedaK., IwaM., SakitaM.. Effects of electroacupuncture and transcutaneous electrical nerve stimulation on survival of musculocutaneous flap in rats.Am J Chin Med1997; 25: 273–80.
15.
KragC., TaudorfU., SiimE., BolundS.. The effect of pulsed eletromagnetic energy (Diapulse) on the survival of experimental skin flaps.Scand J Plast Reconstr Surg1979; 13: 377–80.
16.
KamiT., YoshimuraY., NakajimaT., OhshiroT., FujinoT.. Effects of low-power diode lasers on flap survival.Ann Plast Surg1985; 14: 278–83.
17.
SmithR.J., BirndorfM., GluckG., HammondD., MooreW.D.. The effect of low-energy laser on skin-flap survival in the rat and porcine animal models.Plast Reconstr Surg1992; 89: 306–10.
18.
AmirA., SolomonA.S., GilerS., CordobaM., HaubenD.J.. The influence of helium-neon laser irradiation on the viability of skin flaps in the rat.Br J Plast Surg2000; 53: 58–62.
19.
ImJ.M., LeeW.P.A., HoopesJ.E.. Effect of electrical stimulation on survival of skin flaps in pigs.Phys Ther1990; 70: 37–40.
20.
KjartanssonJ., LundebergT.. Effects of electrical nerve stimulation (ENS) in ischemic tissue.Scand J Plast Reconstr Hand Surg1990; 24: 129–34.
21.
ScuddsR.J., HelewaA., ScuddsR.A.. The effects of transcutaneous electrical nerve stimulation on skin temperature in assintomatic subjects.Phys Ther1995; 75: 622–8.
22.
McFarlaneR.M., DeYoungG., HenryR.A.. The design of a pedicle flap in the rat to study necrosis and its prevention.Plast Reconstr Surg1965; 35: 177–82.
23.
GomesH.F.C., BuenoP.C.S., ScardoeliC.A.C., FerreiraL.M.. Effect of nicotine in randomized skin flaps in rats.Rev Hosp S Paulo Esc Paul Med1994; 5: 13–7.
24.
KaufmanT., AngelM.F., EichenlaubE.H., LevinM., HurwitzD.J., FutrellJ.. The salutary effects of the bed on the survival of experimental flaps.Ann Plast Surg1985; 14: 64–73.
25.
SasakiG.H., PangC.Y.. Hemodynamics and viability of acute neurovascular island skin flap in rats.Plast Reconstr Surg1980; 65: 152–8.
ReinishJ.F., MyersM.B.. Survival of experimental flaps pretreated with low-intensity direct current electrical delay.Surg Forum1974; 25: 522–3.
28.
BenediktssonK.P., PerbeckL., GeigantE., SoldersG.. Touch sensibility in the breast after subcutaneous mastectomy and immediate reconstruction with a prosthesis.Br J Plast Surg1997; 50: 443–9.
29.
EbersoldM.L., LawsE.R., AlbersJ.W.. Measurements of autonomic function before, during and after transcutaneous stimulation in patients with chronic pain and in control subjects.Mayo Clin Proc1977; 52: 228–32.
30.
WongR.A., JetteP.V.. Changes in sympathetic tone associated with different forms of transcutaneous electrical nerve stimulation in healthy subject.Phys Ther1984; 64: 478–82.
31.
OwensS., AtkinsonE.R., LeesD.E.. Thermographic evidence of reduced sympathetic tone with transcutaneous nerve stimulation.Anesthesiology1979; 50: 62–5.
32.
AbramE.S., AsiddaoC.B., ReynoldsA.C.. Increased skin temperature during transcutaneous electrical stimulation.Anesth Analg1980; 59: 22–5.
33.
LinderothB., GunasekeraL., MeyersonB.A.. Effects of sympathectomy on skin and muscle microcirculation during dorsal column stimulation: Animal studies.Neurosurgery1991; 29: 874–9.
CerveroF., LairdJ.M.A.. Mechanisms of touch-evoked pain (allodynia): A new model.Pain1996; 68: 13–23.
36.
WasnerG., BaronR., JänigW.. Dynamic mechanical allodynia in humans is not mediated by a central presynaptic interaction of Abmechanoreceptive and nociceptive C-afferents.Pain1999; 79: 113–9.
37.
KaadaB.. Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia (Raynaud's phenomenon and diabetic polyneuropathy).Eur Heart J1984; 3: 303–14.
38.
KaadaB., OlsenE., EielsenO.. In search of mediators of skin vasodilatation induced by transcutaneous nerve stimulation: III. Increase in plasma VIP in normal subjects and in Raynaud's disease.Gen Pharmac1984; 15: 107–13.
