PREOPERATIVE PREPARATION OF DONOR ZONES OF PERFORANT FLAPS BY THE METHOD OF TRAINING PERFORANT VESSELS WITH NEGATIVE...

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Regenerative Medicine

Background:

• Identifying recipient vessels is critical for successful reconstructive surgery using perforant flaps.
• Difficulties in vessel identification occur during both surgical planning and operation.
• Local vacuum (VAC) therapy is explored for preoperative donor site preparation.

Purpose of the Study:

• To determine optimal parameters for local negative pressure application on thigh skin.
• To enhance the preoperative identification and visualization of perforant vessels for flap surgery.
• To improve blood supply to the donor area for better surgical outcomes.

Main Methods:

• Utilized a negative pressure apparatus ('AGAT-Dnepr') to apply local vacuum (VAC) to the anterior thigh surface of 35 healthy volunteers.
• Employed a Flir ONE thermal imager for preoperative identification of perforants.
• Evaluated perforant vessel visualization at various time intervals (30 minutes to 48 hours) and pressure levels (-100 mmHg, -130 mmHg, -160 mmHg).

Main Results:

• Optimal results were achieved with 30 minutes of VAC therapy at -130 mmHg, revealing 10-14 perforants.
• This pressure and duration significantly increased perforant visualization compared to -100 mmHg (p<0.001).
• Local negative pressure promoted the opening of second and third-level perforants, enhancing donor site vascularity.

Conclusions:

• A 30-minute application of local negative pressure at -130 mmHg is the most effective mode for preparing thigh donor sites for perforant flap surgery.
• This technique improves perforant vessel identification and blood supply, potentially reducing postoperative complications.
• Preconditioning donor sites with local negative pressure and cooling 2-3 days before surgery may further enhance outcomes.