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The Delay Phenomenon: Is One Surgical Delay Technique Superior?

Robert P Gersch1, Mitchell S Fourman1, Cristina Dracea1

  • 1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.; and Department of Surgery, Division of Plastic and Reconstructive Surgery Stony Brook Medicine, Stony Brook, N.Y.

Plastic and Reconstructive Surgery. Global Open
|November 30, 2017
PubMed
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The bipedicle surgical delay (BSD) technique significantly improved flap survival by increasing viable surface area and reducing flap contraction compared to controls. This study suggests BSD is superior for preclinical flap modeling.

Area of Science:

  • Plastic Surgery
  • Surgical Techniques
  • Tissue Engineering

Background:

  • Surgical delay is crucial for enhancing flap survival, but optimal techniques require further investigation.
  • Comparing different surgical delay methods is essential for improving reconstructive surgery outcomes.
  • This study evaluates two distinct surgical delay techniques to determine their efficacy.

Purpose of the Study:

  • To compare the efficacy of incisional surgical delay versus bipedicle surgical delay (BSD) in improving flap survival.
  • To analyze flap perfusion, viable surface area, and flap contraction in response to different surgical delay methods.
  • To establish an optimal surgical delay technique for preclinical flap research.

Main Methods:

  • Male Sprague-Dawley rats were allocated into three groups: incisional surgical delay, bipedicle surgical delay (BSD), and control.

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  • Dorsal flaps were subjected to specific delay procedures (incisional or bipedicle) or no delay (control).
  • Flap viability, perfusion (Laser Doppler Imaging), and contraction were assessed on postoperative days 0, 3, and 7.

    • Main Results:

    • The bipedicle surgical delay (BSD) group exhibited significantly greater viable surface area (13.7 cm²) compared to the control group (8.7 cm²) on postoperative day 7.
    • BSD demonstrated significantly less flap contraction (21.0%) than the control group (45.9%) on postoperative day 7.
    • Both BSD and incisional surgical delay showed increased perfusion compared to controls on postoperative days 0 and 3, with this effect diminishing by postoperative day 7.

    Conclusions:

    • The bipedicle surgical delay (BSD) technique significantly enhances early perfusion, increases viable surface area, and reduces flap contraction.
    • BSD proves to be a superior flap design for preclinical modeling compared to control and incisional delay.
    • These findings support the adoption of BSD for improved outcomes in experimental flap research.