Comparison of two different laser photobiomodulation protocols on the viability of random skin flap in rats

  • Cintia Cristina Santi MartignagoEmail author
  • C. R. Tim
  • L. Assis
  • L. M. G. Neves
  • P. S. Bossini
  • A. C. Renno
  • L. R. S. Avo
  • R. E. Liebano
  • N. A. Parizotto
Original Article


To identify the best low level laser photobiomodulation application site at the same irradiation time to increase the viability of the skin flap in rats. Eighteen male rats (Rattus norvegicus: var. Albinus, Rodentia Mammalia) were randomly distributed into three groups (n = 6). Group I (GI) was submitted to simulated laser photobiomodulation; group II (GII) was submitted to laser photobiomodulation at three points in the flap cranial base, and group III (GIII) was submitted to laser photobiomodulation at 12 points distributed along the flap. All groups were irradiated with an Indium, Galium, Aluminum, and Phosphorus diode laser (InGaAlP), 660 nm, with 50 mW power, irradiated for a total time of 240 s in continuous emission mode. The treatment started immediately after performing the cranial base random skin flap (10 × 4 cm2 dimension) and reapplied every 24 h, with a total of five applications. The animals were euthanized after the evaluation of the percentage of necrosis area, and the material was collected for histological analysis on the seventh postoperative day. GII animals presented a statistically significant decrease for the necrosis area when compared to the other groups, and a statistically significant increase in the quantification of collagen when compared to the control. We did not observe a statistical difference between the TGFβ and FGF expression in the different groups evaluated. The application of laser photobiomodulation at three points of the flap cranial base was more effective than at 12 points regarding the reduction of necrosis area.


Skin flap Tissue viability Laser photobiomodulation Collagen Transforming growth factor beta and fibroblast growth factor 


Funding Information

This study was financially supported by the Brazilian funding agency FAPESP (project #2015/13501-3), CAPES and CNPQ (309308/2017-8)


  1. 1.
    Krammer CW, Ibrahim RM, Hansen TG, Sørensen JA (2015) The effects of epinephrine and dobutamine on skin flap viability in rats: a randomized double-blind placebo-controlled study. J Plast Reconstr Aesthetic Surg 68:113–119. CrossRefGoogle Scholar
  2. 2.
    Kerrigan C (1983) Skin flap failure: pathophysiology. Plast Reconstr Surg 72:766–777CrossRefGoogle Scholar
  3. 3.
    Frederick JW, Sweeny L, Carroll WR et al (2013) Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 123:1612–1617. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baldan CS, Masson IFB, Júnior IE, Baldan AMS, Machado AFP, Casaroto R, Liebano RE (2015) Inhibitor effects of low-level laser therapy on skin-flap survival in a rat model. Past Surg 23:35–39Google Scholar
  5. 5.
    Baldan CS, Pasqual A, Marques et al (2012) The effects of different doses of 670 nm diode laser on skin flap survival in rats. Acta Cirúrgica Bras 27:155–161. CrossRefGoogle Scholar
  6. 6.
    Cury V, Moretti AI, Assis L et al (2013) Low level laser therapy increases angiogenesis in a model of ischemic skin flap in rats mediated by VEGF, HIF-1alpha and MMP-2. JPhotochemPhotobiolB 125:164–170Google Scholar
  7. 7.
    Nishioka MA, Pinfildi CE, Sheliga TR et al (2012) LED (660 nm) and laser (670 nm) use on skin flap viability: angiogenesis and mast cells on transition line. Lasers Med Sci 27:1045–1050. CrossRefPubMedGoogle Scholar
  8. 8.
    Gupta A, Dai T, Hamblin MR (2014) Effect of red and near-infrared wavelengths on low-level laser ( light ) therapy-induced healing of partial-thickness dermal abrasion in mice. 257–265.
  9. 9.
    Costa MS, Pinfildi CE, Gomes HC et al (2010) Effect of low-level laser therapy with output power of 30 mW and 60 mW in the viability of a random skin flap. Photomed Laser Surg 28:57–61. CrossRefPubMedGoogle Scholar
  10. 10.
    Bossini PS, Fangel R, Habenschus RM et al (2009) Low-level laser therapy (670 nm) on viability of random skin flap in rats. Lasers Med Sci 24:209–213. CrossRefPubMedGoogle Scholar
  11. 11.
    Gribbe O, Samuelson UE, Wiklund NP (2007) Effects of nitric oxide synthase inhibition on blood flow and survival in experimental skin flaps. J Plast Reconstr Aesthet Surg 60:287–293. CrossRefPubMedGoogle Scholar
  12. 12.
    Balasubramanian P, Prabhakaran MP, Sireesha M, Ramakrishna S (2012) Collagen in human tissues: structure, function, and biomedical implications from a tissue engineering perspective. Adv Polym Sci 251:173–206CrossRefGoogle Scholar
  13. 13.
    Barrientos S, Stojadinovic O, Golinko MS et al (2008) Growth factors and cytokines in wound healing. Wound Repair Regen 16:585–601. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    White LA, Mitchell TI, Brinckerhoff CE (2000) Transforming growth factor β inhibitory element in the rabbit matrix metalloproteinase-1 (collagenase-1) gene functions as a repressor of constitutive transcription. Biochim Biophys Acta - Gene Struct Expr 1490:259–268. CrossRefGoogle Scholar
  15. 15.
    Houreld NN, Ayuk SM, Abrahamse H (2014) Expression of genes in normal fibroblast cells (WS1) in response to irradiation at 660 nm. J Photochem Photobiol B Biol 130:146–152. CrossRefGoogle Scholar
  16. 16.
    das Neves LMS, Leite G de PMF, Marcolino AM et al (2017) Laser photobiomodulation (830 and 660 nm) in mast cells, VEGF, FGF, and CD34 of the musculocutaneous flap in rats submitted to nicotine. Lasers Med Sci 32:335–341. CrossRefPubMedGoogle Scholar
  17. 17.
    Park IS, Mondal A, Chung PS, Ahn JC (2015) Prevention of skin flap necrosis by use of adipose-derived stromal cells with light-emitting diode phototherapy. Cytotherapy 17:283–292. CrossRefPubMedGoogle Scholar
  18. 18.
    Hersant B, SidAhmed-Mezi M, Bosc R, Meningaud JP (2015) Current indications of low-level laser therapy in plastic surgery: a review. Photomed Laser Surg 33:283–297. CrossRefPubMedGoogle Scholar
  19. 19.
    Prado RP, Garcia SB, J a T, Piccinato CE (2012) Effects of 830 and 670 nm laser on viability of random skin flap in rats. Photomed Laser Surg 30:418–424. CrossRefPubMedGoogle Scholar
  20. 20.
    Esteves I, Masson IB, Oshima CTF et al (2012) Low-level laser irradiation, cyclooxygenase-2 (COX-2) expression and necrosis of random skin flaps in rats. Lasers Med Sci 27:655–660. CrossRefGoogle Scholar
  21. 21.
    Amir A, Solomon AS, Giler S et al (2000) The influence of helium-neon laser irradiation on the viability of skin flaps in the rat. Br J Plast Surg 53:58–62 53:5862CrossRefGoogle Scholar
  22. 22.
    Kubota J (2002) Effects of diode laser therapy on blood flow. Lasers Med Sci 17:146–153CrossRefGoogle Scholar
  23. 23.
    Pinfildi CE, Liebano RE, Hochman BS, Ferreira LM (2005) Helium-neon laser in viability of random skin flap in rats. Lasers Surg Med 37:74–77. CrossRefPubMedGoogle Scholar
  24. 24.
    Prado RP, Pinfildi CE, Liebano RE et al (2009) Effect of application site of low-level laser therapy in random cutaneous flap viability in rats. Photomed Laser Surg 27:411–416. CrossRefPubMedGoogle Scholar
  25. 25.
    RM MCFARLANE, DEYOUNG G, RA HENRY (1965) The design of a pedicle flap in the rat to study necrosis and its prevention. Plast Reconstr Surg 35:177–182CrossRefGoogle Scholar
  26. 26.
    Sasaki GH, Pang CY (1980) Hemodinamics and viability of acute neurovascular island skin flaps in rats. Plast Reconstr Surg 65:152–158CrossRefGoogle Scholar
  27. 27.
    Manni ML, Czajka CA, Oury TD, Gilbert TW (2011) Extracellular matrix powder protects against bleomycin-induced pulmonary fibrosis. Tissue Eng Part A 17:2795–2804. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kashimura T, Soejima K, Asami T et al (2015) The effect of mature adipocyte-derived dedifferentiated fat (DFAT) cells on a dorsal skin flap model. J Investig Surg 1939:1–7. CrossRefGoogle Scholar
  29. 29.
    Huang YY, Chen ACH, Carroll JD, Hamblin MR (2009) Biphasic dose response in low level lightherapy. Dose-Response 7:358–383. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hamblin MR, Huang YY, Sharma SK, Carroll J (2011) Biphasic dose response in low level light therapy - an update. Dose-Response 9:602–618. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Jenkins PA, Carroll JD (2011) How to report low-level laser therapy (LLLT)/photomedicine dose and beam parameters in clinical and laboratory studies. Photomed Laser Surg 29:785–787. CrossRefPubMedGoogle Scholar
  32. 32.
    Enwemeka CS (2009) Intricacies of dose in laser phototherapy for tissue repair and pain relief. Photomed Laser Surg 27:387–393. CrossRefPubMedGoogle Scholar
  33. 33.
    Otterço AN, Andrade AL, Brassolatti P et al (2018) Photobiomodulation mechanisms in the kinetics of the wound healing process in rats. J Photochem Photobiol B Biol 183:22–29. CrossRefGoogle Scholar
  34. 34.
    Figurová M, Ledecký V, Karasová M et al (2016) Histological assessment of a combined low-level laser/light-emitting diode therapy (685 nm/470 nm) for sutured skin incisions in a porcine model: a short report. Photomed Laser Surg 34:53–55. CrossRefPubMedGoogle Scholar
  35. 35.
    Gonçalves RV, Sarandy MM, da Matta SLP et al (2013) Comparative study of the effects of laser photobiomodulation and extract of Brassica oleracea on skin wounds in wistar rats: a histomorphometric study. Pathol Res Pract 209:648–653. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Cintia Cristina Santi Martignago
    • 1
    Email author return OK on get
  • C. R. Tim
    • 2
    • 3
  • L. Assis
    • 2
    • 3
  • L. M. G. Neves
    • 1
  • P. S. Bossini
    • 4
  • A. C. Renno
    • 2
  • L. R. S. Avo
    • 1
  • R. E. Liebano
    • 1
  • N. A. Parizotto
    • 1
    • 3
  1. 1.Department of Physiotherapy, Federal University of São CarlosSão CarlosBrazil
  2. 2.Federal University of São PauloSantosBrazil
  3. 3.Biomedical EngineeringUniversity BrasilSão PauloBrazil
  4. 4.Researcher of the Nucleus of Research and Teaching of Phototherapy in Health SciencesSão CarlosBrazil

Personalised recommendations