Effects of venous supercharging in deep inferior epigastric artery perforator flap

Abstract

Purpose:To evaluate the effects of venous supercharging in deep inferior epigastric artery perforator fl ap in rats. Methods: 20 Wistar rats were randomized in 2 groups: control group (C), all had fl aps raised based on the deep inferior epigastric perforator vessels (DIEP), and experimental group (E), which was identical to group C, except that the contralateral superfi cial inferior epigastric vein was also kept with the fl ap. Flow studies using laser Doppler fl owmetry where performed daily in the four zones of the fl ap. On the 7th postoperative day rats were killed and fl ap survival was determined using digital planimetry. Results: Flow values were presented as a percentage of the baseline fl ow after incision of the fl ap edges. The surviving fl ap area was demonstrated as a percentage of the total fl ap area. Evaluation by digital planimetry showed that fl ap survival in group E was higher than in group C (97,38%±1,32%vs.44,13%±4,83%, p=0,0006). Conclusion: This study shows that venous supercharging of the rat DIEP fl ap results in greater fl ap survival. Key words: Surgical Flaps. Tissue Survival. Models, Animal. Laser-Doppler Flowmetry. Rats. RESUMO Objetivo:Avaliar o efeito da vascularização venosa ampliada na viabilidade do retalho perfurante da artéria epigástrica profunda em ratos. Métodos: Vinte ratos foram divididos em 2 grupos: controle(C), no qual se realizou o retalho perfurante da artéria epigástrica profunda e experimento(E), no qual se realizou o mesmo retalho e se manteve a veia epigástrica superfi cial inferior contralateral ao pedículo. Foi realizada determinação diária do fl uxo sanguíneo por fl uxometria por laser-doppler em quatro quadrantes do retalho previamente estabelecidos e a viabilidade foi determinada, no 7º pós-operatório, através de planimetria. Resultados: A análise do fl uxo sangüíneo demonstrou não haver diferença entre o grupo C e E nas médias de fl uxo entre as zonas do retalho (Zona I:103,44±8,09vs.84,70±7,98, p=0,114) (Zona II: 109,18±6,99 vs. 113,67±26,89, p=0,401) (Zona III: 89,15±11,11 vs. 106,79±15,93, p=0,599) (Zona IV: 104,43±11,50 vs. 124,90±23,17, p=1,00). A viabilidade do grupo E foi superior do que no grupo C quando determinada por planimetria digital (97,38%±1,32% vs. 44,13%±4,83%, p=0,0006). Conclusão: Há aumento da viabilidade do retalho DIEP submetidos à supercharging. Descritores: Retalhos Cirúrgicos. Sobrevivência de Tecidos. Modelos Animais. Fluxometria por Laser-Doppler. Ratos.

The Influence of Diabetes Mellitus on Survival of Abdominal Perforator Flaps: An Experimental Study in Rats with Slowly Induced Diabetes Mellitus

“…We believe, therefore, that our model reproduces the vascular conditions present in the diabetic patients with nonocclusive microvascular disease but without chronic large vessel disease, which this surgical technique is addressing. We could also show that there is no histopathology of the venous circulation in the diabetic rat and because it is well known that venous flow limitation leads to increased perforator flap failure, [43][44][45][46] the high survival rate of flaps in the diabetic group is also explained. The flaps showed typical recruitment of adjacent perforator territory [33][34][35] by transformation of the shunt anastomoses into functional ones (►Fig.…”

“…Also, there was histologically no evidence of venous structural changes in the diabetic flap group. Knowing that venous insufficiency is the main cause of perforator flap failure, [43][44][45][46] this finding also suggests that there are no structural contraindications for the use of these flaps in the diabetic patients. We can, however, affirm, since the average viable area of the flaps in the diabetic group was only 12,7% lower than in the control group, that the success rate is reasonable, despite the frequent appearance of diabetic ulcerations.…”

What’s the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

“…However, the relative importance of arterial versus venous supercharging in enhancing DIEP flap survival is of wide debates and the conclusions of literatures are conflicted on the animal experiments. Hallock et al [ 14 ] and Groth et al [ 15 ] proposed that venous supercharging of a rat DIEP flap ensured greater flap survival. But in their experiments only venous supercharging was included, while arterial supercharging had not been tested.…”

Retalho do músculo reto abdominal transverso autonomizado em pacientes obesas e fumantes

“…2 Estudos experimentais sobre a vascularização dos vários retalhos miocutâneos e seu território vascular, principalmente do plexo da epigástrica inferior, contribuíram consideravelmente para melhores resultados. [3][4][5][6][7] Alguns trabalhos utilizaram fármacos para avaliar a perfusão e a necrose desses retalhos. 8 Assim, para efetuar uma maior vascularização nesses retalhos, alguns cirurgiões começaram a realizar a "flap delay" (autonomização) 7,9-10 em referência ao chamado "delay phenomenon".…”