Comparison of Different Hemostatic Net Applications on Rat Dorsal Skin Flap Model.

Background: There are several articles discussing the use of a hemostatic net to close dead spaces, but no in-vivo experimental studies have simultaneously examined the histology and tissue perfusion of these techniques.

Objectives: Our aim is to compare variations of the hemostatic net technique commonly used in current practice.

Methods: Two different hemostatic net suturing techniques and two times of suture removal were tested, with a control group for comparison. In the modified McFarlane flap model, hemostatic net sutures are placed in either a vertical or horizontal pattern. Suture removal times are set at 60 hours and 7 days. Perfusion in the proximal, middle and distal parts of the flap was assessed by SPY device assisted immunofluorescence angiography at 0 minutes, 60 hours and 7 days after the first surgery. The rat dorsal flap was photographed in a standardised manner one week after surgery. Flap survival areas were calculated as a percentage using ImageJ software (US National Institute of Health, Bethesda, MD). On day 20, all rats were sacrificed and sent for histological examination.

Results: There was no statistically significant difference in macroscopic flap survival between groups (p>0.05). Group 5 (control) was statistically different with lower neovascularisation scores than the other groups in all three segments (p<0.01).

Conclusions: The hemostatic net may improve neovascularisation at the flap base but does not significantly affect overall flap survival.