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World J Clin Cases. May 16, 2021; 9(14): 3227-3237
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3227
Non-invasive physical therapy as salvage measure for ischemic skin flap: A literature review
Yin-Hua Zheng, Li-Quan Yin, Hai-Kun Xu, Xu Gong
Yin-Hua Zheng, Xu Gong, Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Li-Quan Yin, Department of Rehabilitation Medicine, The Third Hospital of Jilin University, Changchun 130033, Jilin Province, China
Hai-Kun Xu, Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Zheng YH performed the preparation of manuscript; Yin LQ and Xu HK performed literature analysis/search; Gong X performed study design/planning.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu Gong, MD, Doctor, Department of Hand and Foot Surgery, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun 130021, Jilin Province, China. gongxu@jlu.edu.cn
Received: December 21, 2020
Peer-review started: December 21, 2020
First decision: January 17, 2021
Revised: January 26, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: May 16, 2021
Processing time: 129 Days and 6.3 Hours
Abstract

This review focuses on the available evidence regarding the molecular mechanisms and treatment potential of several non-surgical physical therapies for managing flap ischemia to propose a non-invasive, economical, and simple treatment to improve flap survival. A review of the literature was conducted on the topics of various non-invasive methods for the treatment of ischemic necrosis of the distal end of the flap between 1988 and 2019. A total of 52 published studies were reviewed on the applications of hyperbaric oxygen therapy, electrical stimulation therapy, heat stress pretreatment, phototherapy, and vibration therapy to manage skin flap necrosis. The underlying molecular mechanisms of these physical therapies on revitalizing the dying skin flaps were discussed and preliminary clinical uses of these therapies to salvage the necrotic skin flaps were pooled and summarized for clarifying the safety and feasibility of these methods. Various physical therapy regimens have been ushered to manage necrotic development in cutaneous flaps. With the refinement of these new technologies and enhancement of related basic science research on vascular revitalization, the prevention and treatment of flap ischemia will enter a new era.

Keywords: Physiotherapy; Skin flap; Hyperbaric oxygen; Electrical stimulation therapy; Heat stress pretreatment; Phototherapy; Vibration therapy

Core Tip: In this study, the molecular mechanism of physical therapy (such as vascular endothelial growth factor, heat shock protein 32 and heat shock protein 70) was closely linked with the actual clinical application to study the effect of non-invasive physical therapy on ischemic flaps. Its effect of promoting vasodilation and regeneration as well as inhibiting cell apoptosis is also applicable to peripheral vascular lesions caused by diabetes and wound healing. The close connection between molecules and practical applications is conducive to the selection of the right physical therapy methods and parameters to achieve targeted therapy, shorten the treatment time, and alleviate quickly the pain of patients.