Objective: This study aimed to enhance transverse rectus abdominis musculocutaneous (TRAM) flap survival using non-invasive transcutaneous electrical nerve stimulation (TENS) in an experimental rat model.
Materials and Methods: Fifty male rats were divided into four groups. The Control group, consisting of 12 rats, underwent flap surgery only. The Surgical Delay group, also with 12 rats, received skin incisions and superior epigastric artery ligation seven days before flap surgery. The Sham group, comprising 12 rats, had electrodes attached for seven days without stimulation. The TENS group, which included 13 rats, underwent electrical stimulation for seven days before flap surgery. Post-surgery, perfusion was measured, vascular endothelial growth factor (VEGF) levels and vessel counts were assessed, and flap viability was evaluated after seven days.
Results: The TENS group demonstrated higher flap viability compared to the other groups (p=0.097), with viability rates of 17.4±19.80% in the Control group, 18.1±25.70% in the Surgical Delay group, 25.22±29.02% in the Sham group, and 40.44±30.92% in the TENS group. There were no significant differences in perfusion percentages among the groups. The Surgical Delay group exhibited a higher vessel count. VEGF levels were elevated in the TENS and Control groups compared to the Surgical Delay and Sham groups. Significant correlations were observed between perfusion percentages and flap viability.
Conclusion: TENS has been shown to effectively enhance flap viability when used as a preconditioning method in this experimental flap model with axial blood flow. It may be considered a simple preconditioning strategy for high-risk flap designs in clinical settings.