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Perforator flaps--how many perforators are necessary to keep a flap alive?
Andreas M Fichter1, Anna Borgmann1, Lucas M Ritschl1
1Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich 81675, Germany.
The British Journal of Oral & Maxillofacial Surgery
|March 18, 2014
Summary
Increasing perforator vessels and using vascular endothelial growth factor (VEGF) significantly reduced necrosis in reconstructive microsurgery flaps. This finding is crucial for improving flap survival, especially in cases with limited perforator supply.
Area of Science:
- Reconstructive Microsurgery
- Vascular Biology
- Tissue Engineering
Background:
- Perforator flaps are vital in reconstructive surgery due to minimal donor-site morbidity.
- Partial flap necrosis, often due to vasospasm or vessel inconsistency, remains a significant challenge.
- Understanding perforator vessel capacity and angiogenic factors is key to improving flap viability.
Purpose of the Study:
- To evaluate the relationship between the number/capacity of perforator vessels and flap size.
- To investigate the influence of vascular endothelial growth factor (VEGF) on perforator flap capacity.
- To assess methods for reducing necrosis in epigastric perforator flaps in a rat model.
Main Methods:
- Epigastric perforator flaps (4cm×7cm) were created in 36 rats.
- Groups were categorized by the number of perforator vessels (4, 2, or 1) and VEGF administration (control vs. VEGF injection).
- Necrosis was quantified planimetrically; flap viability was assessed using laser Doppler flowmetry, histology, and immunohistochemistry.
Main Results:
- A higher number of perforators, particularly when combined with VEGF, significantly decreased necrotic areas.
- VEGF administration showed a marked benefit in reducing necrosis, especially in flaps with a single perforator.
- Flap success was more dependent on the number of perforators than theoretical models predict.
Conclusions:
- Augmenting perforator vessel count and utilizing proangiogenetic factors like VEGF can substantially enhance perforator flap survival.
- This study highlights the critical role of perforator vessel quantity and the potential of VEGF in mitigating flap necrosis.
- Findings suggest a promising strategy for improving outcomes in reconstructive microsurgery.
