title: Comparison of extracorporal shock wave pretreatment to classic surgical delay in a random pattern skin flap model.
abstract: BACKGROUND
  Extracorporal shock wave therapy has a significant positive effect on rescuing the ischemic zone of flap tissue if applied immediately after surgical intervention. The purpose of this study was to determine the potential preoperative effect of noninvasive extracorporal shock wave therapy to precondition flap tissue compared with the well-established surgical delay procedure.
  
  
  METHODS
  Thirty-two male Wistar rats were randomized into four groups, and an oversized, random-pattern flap was raised in each animal. In group D7, a surgical delay was carried out 1 week before full flap harvest. In group E7, the whole flap area was treated with extracorporal shock wave therapy to induce mechanical delay. Group E7D7 was treated preoperatively with a combination of surgical delay and extracorporal shock wave therapy. Group C constituted the control group, in which the skin flap was harvested without any prior intervention. Seven days after flap harvest, flap survival, perfusion, microvessel density, and vascular endothelial growth factor concentration were assessed.
  
  
  RESULTS
  Flap survival, perfusion, and microvessel density were significantly increased in the delay group (group D7) and the extracorporal shock wave therapy group (group E7) compared with the control group (group C). Combining both pretreatments (group E7D7) did not have a favorable cumulative effect. Vascular endothelial growth factor expression was not significantly increased in any group.
  
  
  CONCLUSIONS
  Although not superior to surgical delay, the authors see many advantages of extracorporal shock wave therapy; it is noninvasive, easily applicable, less time- consuming, and less expensive. Thus, it may constitute an alternative procedure in clinical situations that warrant a noninvasive, fast, and easily applicable treatment.
authors.affiliation: Ludwigshafen and Heidelberg, Germany From the Department of Plastic and Hand Surgery, Burn Center, BG Trauma Center, Ludwigshafen; and Plastic and Hand Surgery, the Department of Neuropathology at the Institute for Pathology, the Division of Neurosurgical Research, Department of Neurosurgery, and the Department of Experimental Surgery, University of Heidelberg.
authors.forename: Matthias Artur
authors.initials: MA
authors.lastname: Reichenberger
authors.forename: Holger
authors.initials: H
authors.lastname: Keil
authors.forename: Wolf
authors.initials: W
authors.lastname: Mueller
authors.forename: Christel
authors.initials: C
authors.lastname: Herold-Mende
authors.forename: Martha Maria
authors.initials: MM
authors.lastname: Gebhard
authors.forename: Günter
authors.initials: G
authors.lastname: Germann
authors.forename: Holger
authors.initials: H
authors.lastname: Engel
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D051381:Rats; D017208:Rats, Wistar; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*