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Background: Distal flap necrosis is a common problemthat is frequently encountered by plastic surgeons. Microneedlingwith a handheld roller device is a minimally invasivemodality that is proposed to improve distal flap circulation,it causes localized dermal injury with rupture of fine dermaland subdermal capillaries. As a result of platelet extravasation,activation and growth factors release, neoangiogenesis occurswhich in turn enhances flap circulation. Our current studyaims to evaluate the efficacy of micro-needling as a minimallyinvasive delay technique.Methods: 20 patients with various defects who met ourinclusion criteria were included. The derma-roller device wasused as a flap delay modality. This was done preoperatively,three days and on the night before surgery. The flap wasdivided into equal halves; The Study half was exposed topreconditioning by micro-needling while the control halfwasn't. All patients were followed-up for one month postoperatively.Results: The mean surface area of defect (length multipliedby width in cm) was 38.9 (±20.37) the minimum was 15 whilethe maximum was. All patients' defects were covered byrandom pattern cutaneous or fascio-cutaneous flaps. The meansurface area of flap used for coverage was 59.85 (±23.78) theminimum was 28 while the maximum was 128. The averagesurface area of distal flap necrosis in the control side was35% meanwhile it was 20% in the study side.Conclusions: Flap preconditioning with micro-needlingmight decrease distal flap necrosis and improve flap survivalin random pattern cutaneous and fasciectomies flaps. It is asimple, minimally invasive modality that could be done as anout-patient procedure.

Evaluation of Micro-Needling as a Flap Preconditioning Modality: A Split-Flap Study