The influence of type of vascular pedicle occlusion on the viability of skin island flaps: a postoperative quantitative assessment of flap survival in an experimental model in rats

Gemperli, Rolf; Munhoz, Alexandre Mendonça

doi:10.1590/s0102-86502013000700002

Cited by 12 publications

(5 citation statements)

References 17 publications

(28 reference statements)

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“…Skin flaps based on random blood supply are frequently indicated for the surgical treatment of skin and soft tissue defects, but are at high risk for ischemia and distal necrosis due to low axial blood flow 1,7,8 . In fact, tissue ischemia is a postoperative complication that can cause partial or full thickness skin flap necrosis with unsatisfactory functional and aesthetic outcome 4 .…”

Section: Discussionmentioning

confidence: 99%

“…In spite of the advantages, random flaps are not reliable and due to the random-pattern distribution of skin vascularization, the technique can be limited by a low blood supply to the subdermal and dermal vascular plexuses. In fact, the distal aspect of a random pattern flap has a high risk of ischemic necrosis, which often results in partial loss of the flap, requiring further reconstructive procedures 1 .…”

Section: Introductionmentioning

confidence: 99%

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Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

et al. 2015

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PURPOSE:To investigate the effect of Botulinum toxin A (BoNTA) on skin flap viability in healthy, tobacco-exposed and diabetic rats. METHODS:Ninety male Wistar rats (250-300g) were randomly divided into six groups: control+saline (C1), control+BoNTA (C2), tobacco-exposed+saline (T1), tobacco-exposed+BoNTA (T2) diabetes+saline (D1) and diabetes+BoNTA (D2). A dorsal cutaneous flap (3×10cm) was performed. Survival area and total area of the flaps were measured. Lumen diameter, external arterial diameter and lumen/wall thickness ratio were recorded. RESULTS:Survival area increased in control group with BoNTA injection compared with control animals injected with saline (C2 x C1; 0.9±0.1 vs 0.67±0.15, p= 0.001). A similar result was found in diabetes group injected with BontA (D2 x D1; 0.97±0.2 vs 0.61±0.24, p=0.018). No difference was observed in skin flap viability in tobacco-exposed groups (T2 x T1; 0.74±0.24 vs 0.64±0.21, p=0.871).Lumen diameter (p= 0.004), external arterial diameter (p = 0.0046,) and lumen/wall thickness ratio (p= 0.003) were increased in diabetes+BoNTA-treated animals. This effect was not observed in control or in tobacco-exposed groups. CONCLUSIONS:Botulinum toxin A increased skin flap viability in control and diabetic rats on the seventh post-operative day.Increased lumen diameter, external arterial diameter, and lumen/wall thickness ratio were observed in the diabetes+BoNTA group.BoNTA had no effect in the tobacco-exposed group on the seventh postoperative day.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…The survival of the skin flap is determined mainly by its vascular pedicle patency 25 , 26 . So, skin flap surgery techniques were suggested to reduce the risks of arterial/venous occlusion and ischemia 25 . In addition, many therapeutic agents have been proven to enhance skin flap survival via the prevention of inflammation, providing free-radical scavenging, increasing angiogenesis, and/or enrichment of the microvascular network 27 .…”

Section: Discussionmentioning

confidence: 99%

Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival

Ellabban

Elmasry

Abdelrahman

et al. 2022

Sci Rep

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Beneficial effects could be achieved by various agents such as nitroglycerin, botulinum toxin A (BoTA), and clopidogrel to improve skin flap ischaemia and venous congestion injuries. Eighty rats were subjected to either arterial ischaemia or venous congestion and applied to a bipedicled U-shaped superficial inferior epigastric artery (SIEA) flap with the administration of nitroglycerin, BoTA, or clopidogrel treatments. After 7 days, all rats were sacrificed for flap evaluation. Necrotic area percentage was significantly minimized in flaps treated with clopidogrel (24.49%) versus the ischemic flaps (34.78%); while nitroglycerin (19.22%) versus flaps with venous congestion (43.26%). With ischemia, light and electron microscopic assessments revealed that nitroglycerin produced degeneration of keratinocytes and disorganization of collagen fibers. At the same time, with clopidogrel administration, there was an improvement in the integrity of these structures. With venous congestion, nitroglycerin and BoTA treatments mitigated the epidermal and dermal injury; and clopidogrel caused coagulative necrosis. There was a significant increase in tissue gene expression and serum levels of vascular endothelial growth factor (VEGF) in ischemic flaps with BoTA and clopidogrel, nitroglycerin, and BoTA clopidogrel in flaps with venous congestion. With the 3 treatment agents, gene expression levels of tumor necrosis factor-α (TNF-α) were up-regulated in the flaps with ischemia and venous congestion. With all treatment modalities, its serum levels were significantly increased in flaps with venous congestion and significantly decreased in ischemic flaps. Our analyses suggest that the best treatment option for ischemic flaps is clopidogrel, while for flaps with venous congestion are nitroglycerin and BoTA.

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“…b , left panel) towards the left inferior epigastric region ( Fig . b , right panel), was outlined according to the anatomy of rat inguinal vessels and the rat hypogastric four‐angiosome flap.…”

Section: Methodsmentioning

confidence: 99%

Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply

Wang

Chen

Gao

et al. 2015

British Journal of Surgery

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The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.

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The influence of type of vascular pedicle occlusion on the viability of skin island flaps: a postoperative quantitative assessment of flap survival in an experimental model in rats

Abstract: The arterial suppy/venous drainage is important for flap circulation up to five days following pedicle occlusion. After this period, the pedicle can be interrupted once the circulation through the flap margins has already been established.

Cited by 12 publications

References 17 publications

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival

Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply

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