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[Influence of pedicle length on perforator flap in hemodynamics]
Yufeng Liu1, Lai Gui, Zhiyong Zhang
1Department of Maxillo-Facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100041, P.R. China. plastic-liu@163.com
Objective:
To study the influence of the pedicle length on the perforator flaps in hemodynamics.
Methods:
Four mature swine (2 males, 2 females; weight, 23.0 +/- 2.0 kg) were applied to the experiment. Two transverse abdominal skin flaps, based on the superior epigastric pedicle or its rectus abdominal muscle perforators, were designed; each swine was used as its own control. At 2 hours and 1, 2, 3 weeks postoperatively, the skin paddle perfusion and the blood stream velocity in the superior epigastric artery were measured by the Laser Doppler Flowmeter and the Color Doppler Ultrasound, respectively. Flap survival percentages were calculated by the grid method at 1 week postoperatively. The swine were euthanatized, and they underwent angiography at 3 weeks postoperatively.
Results:
At 2 hours and 1 week after operation, edema of the perforator flaps with the superior epigastric pedicle was more severe than that of the skin flaps with the rectus abdominal muscle perforator, and the skin perfusion had a statistical difference between the two kinds of flaps (P<0.05). The skin paddle viability and the skin perfusion had no statistical difference after the first week postoperatively (P>0.05). At 2 hours and 1 week after operation, the blood stream velocity in the superior epigastric artery in the perforator flap with the superior abdominal artery pedicle was reduced, and there was a statistical difference between the two kinds of flaps (P<0.05); however, the velocity was almost the same after the first week postoperatively.
Conclusion:
The excessively long pedicle of the perforator skin flap may have an unfavorable influence on the flap perfusion, especially during the first week after operation, because of the vascular compromise during the dissection of the long pedicle. The blood vessel anastomosis at this level of the blood vessels may have no relationship with the perforator flap in hemodynamics. This study can also indicate that the ligation of the branches in the recipient vessels cannot make the perforator flaps overperfused.
