Skin flap survival. Influence of infection, anemia, and tubing

The use of regional skin flaps in reconstructive head and neck surgery is well established. The specific factors that influence the survival of the various skin flaps are numerous. An experimental approach to this problem has been outlined and carried out. Rabbits were used to evaluate the effect of severe anemia on pedicle skin flap survival. Infected as well as noninfected flaps were studied. Skin flaps of various length-to-width ratios were placed on the backs of each rabbit. These flaps included the full-thickness skin and the panniculus carnosus. Some animals were infected with pure cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Some animals were made anemic by slowly bleeding them until the desired hematocrit leading was achieved. The best flap survivals occurred in the noninfected, anemic group. The next best survival percentage was noted in the noninfected group with normal hematocrit readings. The poorest survival was noted in rabbits with a normal hematocrit reading and infection. In all groups, flattened pedicled grafts had better survival than tubed pedicled grafts.