The effect of controlled carbon dioxide insufflation on the viability of ischemic random skin flaps in rats

Background Despite the indications of carboxitherapy in situations of ischemia and necrosis, there is still no scientific evidence to support its clinical applicability. The purpose of this study was to investigate the effect of controlled carbon dioxide insufflation on the viability of dorsal ischemic random skin flaps in rats. Methods A randomized, single-blind, experimental study was conducted. Thirty-six Wistar-EPM rats were randomly distributed into three groups: group 1 (control using ischemic random skin flap procedure without gas insufflation); group 2 (flap procedure with controlled carbon dioxide insufflation); and group 3 (flap procedure with controlled inert gas insufflation). In groups 2 and 3, gas was insufflated intradermally in rats for 5 s (150 ml/min) using a 0.2-mm needle inserted at a 90° angle to the skin at two points (one located 2.5 cm from the cranial base of the flap and the other 7.5 cm from the midline of the flap). This procedure was repeated for 7 consecutive days. Macroscopic analysis (necrotic area) was performed using the paper-template method proposed by Sasaki and Pang. Microscopic analysis of the vascularization process was performed using hematoxylin and eosin staining. Results No statistically significant differences were found for the parameter vascularization, inflammatory infiltrate, and percentage of necrotic area. Conclusions Controlled carbon dioxide insufflation did not have a significant impact on the viability of ischemic random skin flaps. Level of evidence: Not ratable.