Effects of extremely low-frequency sinusoidal electromagnetic field therapy on survival and vascularization in a rat random-pattern skin flap model

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Esmer M. G., Onal A. O., Onal M., Demir S., Yurtoglu S., SERİN M.

JPRAS Open, cilt.50, ss.585-600, 2026 (ESCI, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 50
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1016/j.jpra.2026.05.040
  • Dergi Adı: JPRAS Open
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals
  • Sayfa Sayıları: ss.585-600
  • Anahtar Kelimeler: Angiogenesis, Apoptosis, Electromagnetic field, Random-pattern skin flap, Wound healing
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Maltepe Üniversitesi Adresli: Evet

Özet

Aim: This study aimed to evaluate the dose-dependent effects of extremely low-frequency sinusoidal electromagnetic fields (ELF-EMF) on survival and vascularization of random-pattern dorsal skin flaps in rats and to investigate associated histological and molecular changes. Materials and methods: Twenty-one male Sprague-Dawley rats underwent McFarlane dorsal random-pattern flap surgery and were randomly assigned to three groups (n = 7/group): control, low-dose ELF-EMF (0.2 mT), and high-dose ELF-EMF (5 mT). Sinusoidal ELF-EMF exposure (50 Hz) was administered twice daily for 15 min for 14 postoperative days. Flap viability was assessed by digital planimetry. Histological evaluation included hematoxylin-eosin and Masson's trichrome staining. TNF-α immunohistochemistry and quantitative real-time PCR analysis of apoptosis-, inflammation-, and angiogenesis-related genes were performed. Results: The low-dose ELF-EMF group demonstrated significantly higher flap viability than both the control and high-dose groups (76.3 ± 6.9% vs. 55.2 ± 9.1% and 55.7 ± 11.3%, respectively; p < 0.05). Histological analyses showed enhanced re-epithelialization, increased vascularization, improved collagen organization, and reduced inflammatory cell infiltration in the low-dose group. High-dose ELF-EMF did not improve flap survival and was associated with suppression of VEGF and MAPK pathway-related gene expression. The discordance between increased TNF-α mRNA expression and reduced immunohistochemical staining in the low-dose group suggests temporally dynamic and post-transcriptional regulation. Conclusion: Low-dose sinusoidal ELF-EMF improved survival and histological markers of repair in a rat random-pattern skin flap model, whereas high-dose exposure did not confer benefit. These findings support the existence of a dose-dependent biological window for ELF-EMF therapy. Given the exploratory preclinical nature of the study, further mechanistic and translational investigations are required before clinical application.