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

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.

Keywords

Surgery, plastic - Perforator flap - Animal experimentation

This work was funded by the Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Bern, Switzerland.

This work will form part of the PhD thesis of Radu Olariu at the Lucian Blaga University of Sibiu, Sibiu, Romania.

Publikationsverlauf

Eingereicht: 09. Juli 2019

Angenommen: 05. März 2020

Artikel online veröffentlicht:
22. März 2022

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