Effect of photodynamic therapy on revascularization of fasciocutaneous flaps.
OBJECTIVE
Photodynamic therapy (PDT) may be used as an adjuvant intraoperative treatment to improve locoregional control. PDT has been shown both to delay wound healing and to have a deleterious effect on flap survival after a primary ischemic insult. This delay in wound healing may make the flap dependent on its pedicled blood supply for a prolonged period. Long-term flap loss may be experienced. The effect of PDT on flap revascularization, with subsequent dependence on its vascular pedicle, is evaluated.


METHODS
Randomized controlled trial using a rodent model.


METHODS
A rat fasciocutaneous flap was used. Study groups were as follows: group I received no treatment; group II received treatment with 630-nm light; groups IH and IV were given Photofrin (in group III, loupes without a fiberoptic light source were used for flap elevation, and in group IV, light source was employed); and group V was given Photofrin and 630-nm light. Primary ischemic times of 2 or 4 hours were used. Vascular pedicles were ligated on postoperative day (POD) 5, 6, or 7, and percentage of flap survival was evaluated 7 days later.


RESULTS
With 2 hours of ischemia, revascularization was decreased in the PDT group on POD 6 (P < .05) and on day 7 (P < .005) when compared with the other groups. With 4 hours of ischemia, revascularization was decreased in the PDT group on PODs 5 (P < .001), 6 (P < .01), and 7 (P < .005).


CONCLUSIONS
Intraoperative PDT decreases revascularization of a rat fasciocutaneous flap.
Belmont
M J
MJ
Department of Otolaryngology--Head and Neck Surgery, University of Pennsylvania, Philadelphia 19104-4283, USA.
Marabelle
N
N
Mang
T S
TS
Hall
R
R
Wax
M K
MK
D000818:Animals; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D004195:Disease Models, Animal; D000071938:Fasciotomy; D006085:Graft Survival / Q000502:physiology; D006258:Head and Neck Neoplasms / Q000601:surgery; D007511:Ischemia / Q000628:therapy*; D008297:Male; D018919:Neovascularization, Physiologic / Q000502:physiology; D010778:Photochemotherapy / Q000379:methods*; D011183:Postoperative Complications; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing