Background: Distal flap necrosis is a common problem
that is frequently encountered by plastic surgeons. Microneedling
with a handheld roller device is a minimally invasive
modality that is proposed to improve distal flap circulation,
it causes localized dermal injury with rupture of fine dermal
and subdermal capillaries. As a result of platelet extravasation,
activation and growth factors release, neoangiogenesis occurs
which in turn enhances flap circulation. Our current study
aims to evaluate the efficacy of micro-needling as a minimally
invasive delay technique.
Methods: 20 patients with various defects who met our
inclusion criteria were included. The derma-roller device was
used as a flap delay modality. This was done preoperatively,
three days and on the night before surgery. The flap was
divided into equal halves; The Study half was exposed to
preconditioning by micro-needling while the control half
wasn't. All patients were followed-up for one month postoperatively.
Results: The mean surface area of defect (length multiplied
by width in cm) was 38.9 (±20.37) the minimum was 15 while
the maximum was. All patients' defects were covered by
random pattern cutaneous or fascio-cutaneous flaps. The mean
surface area of flap used for coverage was 59.85 (±23.78) the
minimum was 28 while the maximum was 128. The average
surface area of distal flap necrosis in the control side was
35% meanwhile it was 20% in the study side.
Conclusions: Flap preconditioning with micro-needling
might decrease distal flap necrosis and improve flap survival
in random pattern cutaneous and fasciectomies flaps. It is a
simple, minimally invasive modality that could be done as an
out-patient procedure.