Effect of photodynamic therapy on revascularization of fasciocutaneous flaps

Objective: Photodynamic therapy (PDT) may be used as an adjuvant intraopera tive 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 d ependent on its pedicled blood supply for a prolonged period. Long-term fla p loss may be experienced. The effect of PDT on flap revascularization, wit h subsequent dependence on its vascular pedicle, is evaluated Study Design: Randomized controlled trial using a rodent model. Methods: A rat fasciocut aneous flap was used, Study groups were as follows: group I received no tre atment; group II received treatment with 630-nm light; groups III and IV we re given Photofrin tin group Ill, loupes without a fiberoptic light source were used for flap elevation, and in group TV, 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 da y (POD) 5, 6, or 7, and percentage of flap survival was evaluated 7 days la ter. 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 t he 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). Conclusi on: Intraoperative PDT decreases revascularization of a rat fasciocutaneous flap.