Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon

Gamze Bektas; Ozlenen Ozkan; Anı Cinpolat; Ibrahim Cumhur Bassorgun; Mehmet Akif Ciftcioglu; Omer Ozkan

doi:10.1055/s-0033-1357281

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2014; 30(08): 531-538
DOI: 10.1055/s-0033-1357281

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon

Gamze Bektas

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University School of Medicine, Antalya, Turkey

,

Ozlenen Ozkan

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University School of Medicine, Antalya, Turkey

,

Anı Cinpolat

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University School of Medicine, Antalya, Turkey

,

Ibrahim Cumhur Bassorgun

²Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey

,

Mehmet Akif Ciftcioglu

²Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey

,

Omer Ozkan

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University School of Medicine, Antalya, Turkey

› Institutsangaben

Abstract

Background The torsion of the flap's pedicle is one of the most common conditions causing vascular compromise. We aimed to compare the resistance to torsion of axial flap pedicle and perforator pedicle patterns. In the second part of the study, we investigated whether the delay phenomenon is an effective method for improving perforator flap resistance to pedicle torsion.

Methods In the first phase, 90 male Wistar rats were randomly divided into two groups: perforator and axial. Bilateral groin flaps were elevated in the axial group and bilateral posterior thigh perforator-based flaps were elevated in the perforator group. Viable flap areas were compared at 90, 180, 270, 360, and 720 degrees of pedicle rotation. Microangiographic and histopathological studies were performed.

Result As a result, necrosis was seen following earlier rotation in the perforator group and viable flap areas were also lower. In the second phase, after delay procedure, the perforator flaps were exposed to 270, 360, and 720 degrees of pedicle rotation. With the delay procedure, no significant difference in viable flap areas was observed.

Conclusion In conclusion, the resistance to torsion of the axial flap pedicle pattern was greater than that of the perforator pedicle pattern, and the delay procedure was not an effective method for improving flap resistance to torsion.

Keywords

perforator flap - torsion - delay phenomenon

Volltext

Referenzen

References
1 Wei FC, Jain V, Suominen S, Chen HC. Confusion among perforator flaps: what is a true perforator flap?. Plast Reconstr Surg 2001; 107 (3) 874-876
2 Chang CH, Lim SY, Pyon JK, Bang SI, Oh KS, Mun GH. The influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg 2009; 25 (9) 533-538
3 Demirseren ME, Yenidunya MO, Yenidunya S. Island rat groin flaps with twisted pedicles. Plast Reconstr Surg 2004; 114 (5) 1190-1194
4 Gökrem S, Sarifakioğlu N, Toksoy K, Terzioğlu A, Aslan G. Effects of 360-° pedicle torsion on island skin flaps: experimental study in rats. J Reconstr Microsurg 2005; 21 (5) 313-316
5 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
6 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
7 Topalan M, Bilgin SS, Ip WY, Chow SP. Effect of torsion on microarterial anastomosis patency. Microsurgery 2003; 23 (1) 56-59
8 Dhar SC, Taylor GI. The delay phenomenon: the story unfolds. Plast Reconstr Surg 1999; 104 (7) 2079-2091
9 Watterson PA, Bostwick III J, Hester Jr TR, Bried JT, Taylor GI. TRAM flap anatomy correlated with a 10-year clinical experience with 556 patients. Plast Reconstr Surg 1995; 95 (7) 1185-1194
10 Morris SF, Taylor GI. The time sequence of the delay phenomenon: when is a surgical delay effective? An experimental study. Plast Reconstr Surg 1995; 95 (3) 526-533
11 Ozgentaş HE, Shenaq S, Spira M. Study of the delay phenomenon in the rat TRAM flap model. Plast Reconstr Surg 1994; 94 (7) 1018-1024 , discussion 1025–1026
12 Coşkunfirat OK, Islamoğlu K, Ozgentaş HE. Posterior thigh perforator-based flap: a new experimental model in rats. Ann Plast Surg 2002; 48 (3) 286-291
13 Ozkan O, Akyürek M, Safak T, Acar B, Ozgentaş HE, Keçik A. Neuromuscular and neuromusculocutaneous flaps in the rat. J Plast Reconstr Aesthet Surg 2006; 59 (3) 279-290
14 Coşkunfirat OK, Okşar HS, Ozgentaş HE. Effect of the delay phenomenon in the rat single-perforator-based abdominal skin flap model. Ann Plast Surg 2000; 45 (1) 42-47
15 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (6) 645-648
16 Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988; 81 (4) 561-566
17 Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003; 50 (1) 90-99
18 Blondeel PN. Soft tissue reconstruction with perforator flaps. In: Siemionow MZ, , ed. Tissue Surgery. London: Springer; 2006: 87-92
19 Hallock GG, Rice DC. Cranial epigastric perforator flap: a rat model of a true perforator flap. Ann Plast Surg 2003; 50 (4) 393-397
20 Okşar HS, Coşkunfirat OK, Ozgentaş HE. Perforator-based flap in rats: a new experimental model. Plast Reconstr Surg 2001; 108 (1) 125-131
21 Ozkan O, Coskunfirat OK, Ozgentas HE. A new experimental flap model: free muscle perforator flap. Ann Plast Surg 2003; 51 (6) 603-606
22 El-Mrakby HH, Milner RH. The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches. Plast Reconstr Surg 2002; 109 (2) 539-543 , discussion 544–547
23 Hallock GG, Rice DC. Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model. Plast Reconstr Surg 2005; 116 (2) 551-555 , discussion 556
24 Acland R. Thrombus formation in microvascular surgery: an experimental study of the effects of surgical trauma. Surgery 1973; 73 (5) 766-771
25 Ozbek MR, Deune EG, Cooley BC, Khouri RK. Experimental reproduction of free flap errors: a new model of thrombosis. Ann Plast Surg 1994; 32 (5) 474-477
26 Guity A, Young PH, Fischer VW. In search of the “perfect” anastomosis. Microsurgery 1990; 11 (1) 5-11
27 Lee HJ, Lim SY, Pyon JK , et al. The influence of pedicle tension and twist on perforator flap viability in rats. J Reconstr Microsurg 2011; 27 (7) 433-438
28 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 (5) 1211-1216
29 Restifo RJ, Ward BA, Scoutt LM, Brown JM, Taylor KJW. Timing, magnitude, and utility of surgical delay in the TRAM flap: II. Clinical studies. Plast Reconstr Surg 1997; 99 (5) 1217-1223
30 Restifo RJ, Syed SA, Ward BA, Scoutt LM, Taylor K. Surgical delay in TRAM flap breast reconstruction: a comparison of 7- and 14-day delay periods. Ann Plast Surg 1997; 38 (4) 330-333 , discussion 333–334