Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2018; 51(02): 196-201
DOI: 10.4103/ijps.IJPS_28_17
Original Article
Association of Plastic Surgeons of India

Comparison of subdermal and perforator delay techniques on a rat flap model

Dincer Altinel
Department of Plastic and Reconstructive Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
,
Burcu Biltekin
1   Department of Histology and Embryology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
,
Merdan Serin
Department of Plastic and Reconstructive Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
,
Ugur Sahin
2   Department of Plastic and Reconstructive Surgery, Bahcelievler Medicana Hospital, Istanbul, Turkey
,
Muzaffer Altindas
3   Department of Plastic and Reconstructive Surgery, Istanbul Diabetes Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

Publication Date:
26 July 2019 (online)

Also available at
   Permissions and Reprints

ABSTRACT

Background: In this study, we investigated the subdermal and perforator delay phenomena as a method to improve flap survival. Materials and Methods: In this experimental study, we used 24 rats in three groups. In the control group, the dorsal flaps were elevated and reinserted back to their place. In the experimental groups, we practiced the delay phenomena with two different techniques. In the first experimental group, cranial and lateral side incisions were performed; however, the flaps were not cut-off from the underlying fascia. In the second experimental group, we placed a silicon sheet under the planned flap to cut-off the circulation from the perforator vessels. Four weeks after the delay procedure, the flaps were raised completely and reinserted back to their place. Results: The average of necrotic area in the control group was 21.9% (±7.70). There was no necrosis in both experimental groups (P < 0.0001). Histological examination revealed that collagen density in both of the experimental groups was increased in comparison to the control group, it has only been found a significant first experimental group (P = 0.0315). We have not found any significant difference in lymphocyte density between the groups. Angiographic imaging has showed an increase in the vascular density in the flaps of the first experimental group. Conclusion: We believe that both of these delay techniques can be adapted to clinical applications and used safely to increase flap survival.

KEY WORDS

Flap delay - rat - skin flap
 

  • REFERENCES

  • 1 Kaufman T, Eichenlaub EH, Levin M, Hurwitz DJ, Klain M. Tobacco smoking: Impairment of experimental flap survival. Ann Plast Surg 1984; 13: 468-72
    CrossrefPubMedGoogle Scholar
  • 2 Cutting C. Critical closing and perfusion pressures in flap survival. Ann Plast Surg 1982; 9: 524
    PubMedGoogle Scholar
  • 3 German C, Koss N. Infection and flap survival. Surg Forum 1977; 28: 533-5
    PubMedGoogle Scholar
  • 4 Reinisch J, Myers B. The effect of local anesthesia with epinephrine on skin flap survival. Plast Reconstr Surg 1974; 54: 324-7
    CrossrefPubMedGoogle Scholar
  • 5 Earle AS, Fratianne RB, Nunez FD. The relationship of hematocrit levels to skin flap survival in the dog. Plast Reconstr Surg 1974; 54: 341-44
    CrossrefPubMedGoogle Scholar
  • 6 Seyhan T, Deniz M, Borman H, Ulusal Güzel B, Cağlar B. Comparison of two different vascular delay methods in a rat cranial epigastric perforator flap model. Ann Plast Surg 2010; 64: 89-92
    CrossrefPubMedGoogle Scholar
  • 7 Yan H, Brooks D, Jackson WD, Angel MF, Akdemir O, Zhang F. et al. Improvement of prearterialized venous flap survival with delay procedure in rats. J Reconstr Microsurg 2010; 26: 193-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Huemer GM, Froschauer SM, Pachinger T, Kwasny O, Schoffl H. A comparison of pretreatment with a topical combination of nonivamide and nicoboxil and surgical delay in a random pattern skin flap model. J Plast Reconstr Aesthet Surg 2009; 62: 914-9
    CrossrefPubMedGoogle Scholar
  • 9 Karacaoglu E, Yuksel F, Turan SO, Zienowicz RJ. Chemical delay: An alternative to surgical delay experimental study. Ann Plast Surg 2002; 49: 73-80
    CrossrefPubMedGoogle Scholar
  • 10 Acikel C, Kenkel JM, Nojima K, Hoopman JE, Saboorian MH, Brown SA. et al. Evaluation of flashlamp-pumped pulsed-dye laser (585 nm) in nonsurgical delay of dorsal rat cutaneous flaps. Plast Reconstr Surg 2005; 115: 2032-41
    CrossrefPubMedGoogle Scholar
  • 11 Belmont MJ, Marabelle N, Mang TS, Hall R, Wax MK. Effect of photodynamic therapy on revascularization of fasciocutaneous flaps. Laryngoscope 2000; 110: 942-5
    CrossrefPubMedGoogle Scholar
  • 12 Stewart RJ, Moore T, Bennett B, Easton M, Newton GW, Yamaguchi KT. et al. Effect of free-radical scavengers and hyperbaric oxygen on random-pattern skin flaps. Arch Surg 1994; 129: 982-7
    Google Scholar
  • 13 Serin M, Bayramicli M. Evaluation of scar penetrating neovascularisation in a rat epigastric flap model. J Plast Surg Hand Surg 2015; 19: 1-5
    Google Scholar
  • 14 Edstrom LE, Robson MC, Hopp D. Survival of skin flaps based on scar. Ann Plast Surg 1981; 7: 44-7
    CrossrefPubMedGoogle Scholar
  • 15 Holzbach T, Neshkova I, Vlaskou D, Konerding MA, Gansbacher B, Biemer E. et al. Searching for the right timing of surgical delay: Angiogenesis, vascular endothelial growth factor and perfusion changes in a skin-flap model. J Plast Reconstr Aesthet Surg 2009; 62: 1534-42
    CrossrefPubMedGoogle Scholar
  • 16 Komorowska-Timek E, Timek TA, Brady S, Buncke HJ. Perfusion, viability, and pedicle dependence in acute and delayed rat island skin flaps. Microsurgery 2007; 27: 146-51
    CrossrefPubMedGoogle Scholar
  • 17 Cohen M, Kattan A, Gat A, Almogi N, Katzir A, Villan A. et al. Comparison of flash lamp pulsed-dye laser (585 nm) and conventional surgery in the delay of random dorsal rat flaps. Lasers Surg Med 1999; 25: 178-86
    CrossrefPubMedGoogle Scholar
  • 18 Reichenberger MA, Keil H, Mueller W, Herold-Mende C, Gebhard MM, Germann G. et al. Comparison of extracorporal shock wave pretreatment to classic surgical delay in a random pattern skin flap model. Plast Reconstr Surg 2011; 127: 1830-7
    CrossrefPubMedGoogle Scholar
  • 19 Mcfarlane RM, Deyoung G, Henry RA. The design of a pedicle flap in the rat to study necrosis and its prevention. Plast Reconstr Surg 1965; 35: 177-82
    CrossrefPubMedGoogle Scholar
  • 20 Quinodoz P, Quinodoz M, Nussbaum JL, Montandon D, Pittet B. Barium sulphate and soft-tissue radiology: Allying the old and the new for the investigation of animal cutaneous microcirculation. Br J Plast Surg 2002; 55: 664-7
    CrossrefPubMedGoogle Scholar
  • 21 Reinisch JF. The pathophysiology of skin flap circulation. The delay phenomenon. Plast Reconstr Surg 1974; 54: 585-98
    CrossrefPubMedGoogle Scholar
  • 22 O'Neill JV, Toomey JM, Snyder 3rd GG. Factors involved in the skin flap delay phenomenon. Surg Forum 1975; 26: 528-30
    PubMedGoogle Scholar
  • 23 Cutting C, Bardach J, Rosewall D. Skin flap delay procedures: Proximal delay versus distal delay. Ann Plast Surg 1980; 4: 293-6
    CrossrefPubMedGoogle Scholar
  • 24 Isoda S, Yano Y, Jin Y, Walters 3rd HL, Kondo J, Matsumoto A. et al. Influence of a delay on latissimus dorsi muscle flap blood flow. Ann Thorac Surg 1995; 59: 632-7
    CrossrefPubMedGoogle Scholar
  • 25 Restifo RJ, Ahmed SS, Isenberg JS, Thomson JG. Timing, magnitude, and utility of surgical delay in the TRAM flap: I. Animal studies. Plast Reconstr Surg 1997; 99: 1211-6
    CrossrefPubMedGoogle Scholar
  • 26 Zhou J, Zhao Y, Wang J, Zhang S, Liu Z, Zhen M. et al. Therapeutic angiogenesis using basic fibroblast growth factor in combination with a collagen matrix in chronic hindlimb ischemia. ScientificWorldJournal 2012; 2012: 652794
    PubMedGoogle Scholar
  • 27 Rao RR, Peterson AW, Ceccarelli J, Putnam AJ, Stegemann JP. Matrix composition regulates three-dimensional network formation by endothelial cells and mesenchymal stem cells in collagen/fibrin materials. Angiogenesis 2012; 15: 253-64
    CrossrefPubMedGoogle Scholar
  • 28 Hallock GG. The rat TRAM flap: A human analogue?. Plast Reconstr Surg 1995; 96: 233-4
    CrossrefPubMedGoogle Scholar
  • 29 Callegari PR, Taylor GI, Caddy CM, Minabe T. An anatomic review of the delay phenomenon: I. Experimental studies. Plast Reconstr Surg 1992; 89: 397-407
    CrossrefPubMedGoogle Scholar
  • 30 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: Experimental study and clinical applications. Br J Plast Surg 1987; 40: 113-41
    CrossrefPubMedGoogle Scholar
  • 31 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: Vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-44
    CrossrefPubMedGoogle Scholar