ABSTRACT
When a perforator flap is transposed in pedicled fashion, twisting, tension, or both can be inflicted on the pedicle. Although high density twisting undoubtedly decreases flap survival, the effect of pedicle tension with or without twisting has not been studied for perforator flaps. The authors designed a model of nonanastomotic pedicle tension using a cranial epigastric perforator flap in rats. Sprague-Dawley rats were divided into 4 groups—control, twist, tension, tension plus twist groups; each group consists of 10 rats. Tension group had lower flap survival ratios than control and the flap survival ratio of tension plus twist group was lower than those of the other groups (p < 0.05). Pedicle tension was found to decrease perforator flap survival and its detrimental effect was exacerbated by twisting. Surgeons need to have a lower threshold for correction of pedicle tension when twisting is combined than without a twist.
KEYWORDS
Pedicled perforator flap - pedicle tension - pedicle twisting
REFERENCES
-
1 Morris S F, Neligan P C, Taylor G I. Free style local perforator flaps. In: Blondeel P N, Morris S F, Hallock G G, Neligan P C, eds. Perforator Flaps: Anatomy, Technique & Clinical Application. St. Louis: Quality Medical Publishing; 2006: 947-960
-
2
Bravo F G, Schwarze H P.
Free-style local perforator flaps: concept and classification system.
J Plast Reconstr Aesthet Surg.
2009;
62
(5)
602-608
discussion 609
-
3
Seyhan T, Ertas N M, Bahar T, Borman H.
Simplified and versatile use of gluteal perforator flaps for pressure sores.
Ann Plast Surg.
2008;
60
(6)
673-678
-
4
Masia J, Moscatiello F, Pons G, Fernandez M, Lopez S, Serret P.
Our experience in lower limb reconstruction with perforator flaps.
Ann Plast Surg.
2007;
58
(5)
507-512
-
5
Jakubietz R G, Jakubietz D F, Gruenert J G, Schmidt K, Meffert R H, Jakubietz M G.
Reconstruction of soft tissue defects of the Achilles tendon with rotation flaps, pedicled propeller flaps and free perforator flaps.
Microsurgery.
2010;
30
(8)
608-613
-
6
Izquierdo R, Dobrin P B, Fu K, Park F, Galante G.
The effect of twist on microvascular anastomotic patency and angiographic luminal dimensions.
J Surg Res.
1998;
78
(1)
60-63
-
7
Salgarello M, Lahoud P, Selvaggi G, Gentileschi S, Sturla M, Farallo E.
The effect of twisting on microanastomotic patency of arteries and veins in a rat model.
Ann Plast Surg.
2001;
47
(6)
643-646
-
8
Demirseren M E, Yenidunya M O, Yenidunya S.
Island rat groin flaps with twisted pedicles.
Plast Reconstr Surg.
2004;
114
(5)
1190-1194
-
9
Demir A, Acar M, Yldz L, Karacalar A.
The effect of twisting on perforator flap viability: an experimental study in rats.
Ann Plast Surg.
2006;
56
(2)
186-189
-
10
Chang C H, Lim S Y, Pyon J K, Bang S I, Oh K S, Mun G H.
The influence of pedicle length on the viability of twisted perforator flaps in rats.
J Reconstr Microsurg.
2009;
25
(9)
533-538
-
11
Chow S P, Huang C D, Chan C W.
Microvascular anastomosis of arteries under tension.
Br J Plast Surg.
1982;
35
(1)
82-87
-
12
Zhang F, Lineaweaver W C, Buntic R, Walker R.
Mechanical evaluation of anastomotic tension and patency in arteries.
J Reconstr Microsurg.
1996;
12
(2)
121-126
-
13
Decherd M E, Calhoun K H.
The effect of tension on patency of rat femoral artery anastomoses.
Arch Facial Plast Surg.
2003;
5
(1)
83-85
-
14
Ozbek M R, Deune E G, Cooley B C, Khouri R K.
Experimental reproduction of free flap errors: a new model of thrombosis.
Ann Plast Surg.
1994;
32
(5)
474-477
-
15
Wong C H, Cui F, Tan B K et al..
Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps.
Ann Plast Surg.
2007;
59
(6)
672-678
-
16
Hallock G G, Rice D C.
Cranial epigastric perforator flap: a rat model of a true perforator flap.
Ann Plast Surg.
2003;
50
(4)
393-397
Goo-Hyun MunM.D.
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
50 Irwon-dong, Gangnam-gu, Seoul 135-710, S. Korea
eMail: supramicro@gmail.com
