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The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model

Archives of Plastic Surgery 2020년 47권 3호 p.209 ~ 216
Olariu Radu, Moser Helen Laura, Lese Ioana, Sabau Dan, Georgescu Alexandru Valentin, Grobbelaar Adriaan Ockert, Constantinescu Mihai Adrian,
소속 상세정보
 ( Olariu Radu ) - Inselspital University Hospital Bern Department of Plastic and Hand Surgery
 ( Moser Helen Laura ) - Inselspital University Hospital Bern Department of Plastic and Hand Surgery
 ( Lese Ioana ) - Inselspital University Hospital Bern Department of Plastic and Hand Surgery
 ( Sabau Dan ) - Lucian Blaga University of Sibiu Victor Papilian Faculty of Medicine Emergency County Hospital Surgical Clinic
 ( Georgescu Alexandru Valentin ) - Iuliu Hatieganu University of Medicine and Pharmacy Rehabilitation Hospital Department of Plastic Surgery
 ( Grobbelaar Adriaan Ockert ) - Inselspital University Hospital Bern Department of Plastic and Hand Surgery
 ( Constantinescu Mihai Adrian ) - Inselspital University Hospital Bern Department of Plastic and Hand Surgery

Abstract


Background: Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival.

Methods: In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap).

Results: Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1.

Conclusions: Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model.

키워드

Surgery, plastic; Perforator flap; Animal experimentation

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