Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats

Abstract

Background Arterial supercharging and venous superdrainage have been the commonly used vascular augmentation techniques for resolving partial loss of flaps in reconstructive surgery. It remains controversial which one of them is more effective in improving flap survival. The purpose of this study was to compare the effect of distal venous superdrainage and arterial supercharging on the survival of an extended dorsal perforator flap in rats. Materials and Methods Sixty Sprague–Dawley rats were randomly divided into three groups (n = 20 in each group). An extended dorsal perforator flap with the size of 3 × 12 cm based on the deep circumflex iliac artery and vein was elevated in each rat. In arterial supercharging group, the thoracodorsal artery was retained as the distal supercharging vessel; In venous superdrainage group, the thoracodorsal vein was retained as the distal superdrainage vessel. In control group, no other arteries and veins were retained except the main vascular pedicle. On the seventh day after operation, the survival area of flap was calculated as a percentage of viable area to the total flap. Vascular changes in the choke zones were assessed by angiography. Microvascular density and diameter were assessed via immunohistochemistry staining of CD31 on the fifth day after operation. Results The flap survival area in arterial supercharging group was significantly higher than that in venous superdrainage group (98.9 ± 0.8% vs. 81.5 ± 3.5%, p < .001). By gross observation, the extent of dilation of choke zone vessels in venous superdrainage group was smaller compared with that in arterial supercharging group. The density of CD31‐positive vessels and the diameter of choke zone vessels in arterial supercharging group were significantly larger than that in venous superdrainage group (23.4 ± 4.6 mm−2 vs. 13.1 ± 4.2 mm−2, p < .05; and 37.5 ± 5.8 μm vs. 27.8 ± 4.9 μm, p < .05). Conclusion Compared with venous superdrainage, distal arterial supercharging in the potential territory resulted in better survival of an extended dorsal perforator flap in a rat model.

Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flaps in 303 Lower Extremity Cases

“…Inner flap anastomosis (also called intraflap anastomosis, or turbocharging) is a powerful technique to reconstruct huge free flaps without necrosis. [23][24][25][26][27][28] However, definition of "a large flap" is not established, and a subjective perspective is involved for determination. Through this study, we tried to investigate the circulation area that a single perforator supplies to anterolateral thigh flaps.…”

Different Transfer Forms of the Expanded Forehead Flap Pedicled With Superficial Temporal Vessels to Treat Chin and Submental Scar Deformities

“…Therefore, this is a good method for treating moderate-scale scars in Zone LC. Some studies have confirmed that only arterial or venous anastomosis can also achieve good effects to the distal end of the flap, which warrants further study 20,21 …”

“…Some studies have confirmed that only arterial or venous anastomosis can also achieve good effects to the distal end of the flap, which warrants further study. 20,21 Unilateral Pedicled Plus Contralateral Super Thin Forehead Flaps When the contralateral vessels are injured or microsurgery cannot be performed for technical reasons, another choice should be applied. We successfully used the super thin flap to solve this problem.…”

Research Advances in Vascular Remodeling in Choke Vessels of Perforator Flap

“…A number of studies encourage reduction of flap necrosis by arterial supercharge. Wang et al 53 found that the extent of dilation of 19 Furthermore, previous studies have shown that the distal arterial supercharging that leads to marked dilation of the choke vessels among the territories is more effective than proximal arterial supercharging. 21 Arterialized venous supercharged (AVS) flap is a "hybrid perfusion" mode by anastomosing a distal vein of the flap with a recipient artery, which is different from the established one of arterial supercharging or venous superdrainage.…”