Time-related variations in viability of random pattern skin flaps: An experimental study in rats

ABSTRACT

Chronobiological variations are in the fabric of life. The first ideas regarding the possible effects of circadian rhythm on surgical outcomes were published in the early 2000s. Some studies support and oppose this idea. The lack of experimental evidence in a controlled setting has led to this study. This study aimed to explore the chronobiological implications of surgical outcomes. The rats were divided into four groups. A random pattern dorsal skin flaps were elevated in all groups at six h intervals. Flap necrosis rates and melatonin, oxidant, and antioxidant factors were studied. Flap survival was better in the 06:00 h group. The flap necrosis was higher in the 18:00 h group. Some of the biochemical parameters displayed circadian variations. As an independent variable, the time of surgical intervention changed the flap survival rates. It should be noted that the study was held in a nocturnal animal model thus the pattern of flap survival can be in reversed fashion in a clinical scenario. This study is the first experimental evidence for “Chronosurgery” in a controlled setting. Further studies in all aspects of surgical disciplines are required.

KEYWORDS:

• Chronobiology
• circadian rhythm
• surgical outcomes
• skin flap
• flap survival
• Chronosurgery

Acknowledgments

The first author would like to thank his mentors, Hakan Zengil, Ph.D. Prof., Cem Zafer Gorgun, MD. Ph.D., and Ishak Ozel Tekin MD. Ph.D. Prof. for their invaluable contributions in attaining chronobiological concepts and a holistic scientific approach between 1994–2000 and onwards. This study is based on the specialty thesis of Kadir Cicek, MD., under the supervision of Osman Enver Aydın, MD. Prof.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data supporting this study’s findings are available from the corresponding author, [OEA], upon reasonable request https://drive.google.com/drive/u/0/folders/1-5Nnu8SxP6dDi8ldty9pj3MCV1DP76Oe.

Additional information

Funding

This study was supported by the ADU-BAP projects under Grant [TPF-20043].