Increasing the flap viability: Truth or myth?

Abstract

Introduction: One question has led us to conduct this study: “Can we increase skin flap viability?” We found many published articles on flap viability in every journal about reconstructive surgery. However, we did not encounter any study on human subjects. The aim of this study is to evaluate the articles that have been published on flap viability in the last 10 years, to find potential agents or methods that can be used for flaps performed on humans. Materials and Methods: English articles published between 2008 and 2017 in the PubMed database were evaluated. The search terms used for this review included “flap viability” and “flap survival.” Details about the test subjects, sample sizes, and interventions and the effects on flap viability were recorded for each study. Results: A total of 995 articles were evaluated according to the inclusion and exclusion criteria; 231 studies were then included in the study and 764 were excluded from the study. No previous study on human subjects was encountered. An increase of flap viability was detected in 209 studies (90.5%), and a decrease was detected in 16 studies (6.9%). Six studies reported no effect on flap viability (2.6%). Conclusion: Although it is inevitable that animal experiments will be undertaken before human experiments, when researchers are planning animal experiments, they should consider how well the methods used can be adapted for human beings. We recommend planning human clinical trials with physical methods such as extracorporeal shockwave therapy, laser therapies, and the chemical agent botulinum toxin A. Physical methods are locally effective methods, and their side effects are well known.

Keywords

• animal experiments
• botulinum toxin
• extracorporeal shockwave therapy
• laser therapy
• surgical flaps