title: Contact Cooling of Random-Pattern Cutaneous Flaps: Does it Increase Necrosis?
abstract: BACKGROUND
  Cooling after surgery reduces pain, swelling and ecchymosis. However, the fear of adverse effects of vasoconstriction caused by cooling may prevent its use when the skin is undermined extensively, for example, after rhytidectomy. The purpose of this study is to determine whether the contact cooling of random-pattern skin flaps increases the area of necrosis observed.
  
  
  METHODS
  Twenty-eight random-pattern skin flaps (4 × 10 cm) were raised on four pigs. Flaps were divided into three groups: control, intermittently cooled and continuously cooled. Pads connected to a ThermaZone cooling device delivered local hypothermia in the range of 4-6 °C for 24 h postoperatively. ImageJ software was used to calculate the area of necrosis on each flap on postoperative day 7, confirmed with histological analysis.
  
  
  RESULTS
  The average areas of necrosis observed were as follows: control (17.61 cm2; SD 5.23), intermittent cooling (15.65 cm2; SD 3.76) and continuous cooling (14.16 cm2; SD 3.91). An ANOVA revealed no statistically significant differences between the three interventions (p = 0.35).
  
  
  CONCLUSIONS
  Postoperative continuous or intermittent cooling does not increase the area of necrosis in random-pattern flaps. In fact, a trend was observed, demonstrating decreasing area of necrosis with increased periods of hypothermia.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
authors.affiliation: Case Western Reserve University SOM, Cleveland, OH, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Nahabet
authors.affiliation: Department of Plastic Surgery, University Hospitals, Case Medical Center, 29017 Cedar Road, Cleveland (Lyndhurst), OH, 44124, USA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Riazi
authors.affiliation: Department of Plastic Surgery, University Hospitals, Case Medical Center, 29017 Cedar Road, Cleveland (Lyndhurst), OH, 44124, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Asirwatham
authors.affiliation: Case Western Reserve University SOM, Cleveland, OH, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Wirtz
authors.affiliation: Department of Plastic Surgery, University Hospitals, Case Medical Center, 29017 Cedar Road, Cleveland (Lyndhurst), OH, 44124, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Harvey
authors.affiliation: Department of Plastic Surgery, University Hospitals, Case Medical Center, 29017 Cedar Road, Cleveland (Lyndhurst), OH, 44124, USA.
authors.forename: Davood
authors.initials: D
authors.lastname: Varghai
authors.affiliation: Department of Plastic Surgery, University Hospitals, Case Medical Center, 29017 Cedar Road, Cleveland (Lyndhurst), OH, 44124, USA. Bahman.guyuron@gmail.com.
authors.forename: Bahman
authors.identifier: http://orcid.org/0000-0002-4557-9402
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000818:Animals; D005260:Female; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D009336:Necrosis / Q000209:etiology; D011182:Postoperative Care; D012867:Skin / Q000098:blood supply* / Q000473:pathology*; D013524:Surgical Flaps / Q000098:blood supply*; D014661:Vasoconstriction
keywords: Cooling; Cutaneous; Flap; Hypothermia; Skin