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Differing flow patterns between ischemically challenged flap skin and flap skeletal muscle: implications for salvage
Kayvan T Khiabani1, Carolyn L Kerrigan
1Microsurgical Research Laboratories, the Royal Victoria Hospital, McGill University, Montreal, Canada.
Plastic and Reconstructive Surgery
|January 12, 2002
Summary
This study reveals critical differences in blood reflow between skin and skeletal muscle flaps after ischemia. Understanding these distinct reflow patterns is vital for improving flap salvage strategies and therapeutic delivery.
Area of Science:
- Plastic Surgery
- Vascular Surgery
- Regenerative Medicine
Background:
- Ischemic insults can compromise flap viability.
- Understanding reflow patterns in different tissue types is crucial for flap salvage.
- Distinct pathophysiologic responses in skin versus muscle flaps post-ischemia are not well-defined.
Purpose of the Study:
- To test the hypothesis of significant differences in spatial reflow patterns between skin and skeletal muscle flaps after ischemic insult.
- To investigate the implications of these differences for flap salvage strategies.
Main Methods:
- Elevated bilateral buttock skin flaps and latissimus dorsi myocutaneous flaps in Landrace pigs (n=7).
- Assigned one side to 6 hours of arterial occlusion, with the contralateral side as control.
- Measured reflow rates using radioactive microspheres at 15 minutes, 1 hour, and 4 hours post-reperfusion; assessed tissue viability via fluorescein and nitroblue tetrazolium.
Main Results:
- Skin flaps with ischemia-reperfusion injury showed significantly reduced flow rates (30-53%) compared to controls.
- Latissimus dorsi flap skin exhibited higher reflow (0.037 ml/min/g at 15 min) than buttock skin flaps (0.018 ml/min/g).
- Muscle flaps with ischemia-reperfusion injury demonstrated significantly higher flow rates than control muscle flaps, indicating an early hyperemic phase.
Conclusions:
- Flap skeletal muscle exhibits an early hyperemic phase during reperfusion, maintaining significant blood flow.
- Flap skin, conversely, experiences a marked decrease in blood flow rates post-ischemia-reperfusion.
- These divergent reflow patterns necessitate exploring alternative therapeutic delivery methods, such as transdermal systems, for salvaging ischemic flap skin.