Comparison of Two Different Vascular Delay Methods in a Rat Cranial Epigastric Perforator Flap Model

Abstract

The effectiveness of vascular delay in transverse rectus abdominis muscle flaps has been demonstrated in many studies. In deep inferior epigastric perforator flaps, however, the effectiveness of ligation of deep versus superficial epigastric vessels in producing delay is unclear. Using a rat model, we compared ligation of deep and superficial vessels with each other and with a (nondelayed) control group (n = 10). One vascular delay group (n = 10) had ligation of the contralateral cranial epigastric vessels (homolog to the human deep inferior epigastric vessels); the other (n = 10) had ligation of contralateral superficial inferior epigastric vessels. One week later, cranial epigastric perforator flap elevation was performed. Both vascular techniques were effective in producing delay, and there was no statistically significant difference between the 2 groups. Ligation of superficial inferior epigastric vessels, deep inferior epigastric vessels, or both, at least 1 week prior to the deep inferior epigastric perforator flap elevation may increase the usable skin paddle area in humans.

The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model

“…Preconditioning of a flap with the purpose of opening the choke vessels that exist between neighboring territories, as an attempt to capture angiosomes that would otherwise be lost, has been clinically and experimentally investigated in models of flap delay 21 22 . Classic delay refers to a flap border incision, while strategic or vascular delay is defined as the specific ligation of vessels before flap elevation 23 . Although we do use selective, specific vessel ligation, we do not induce controlled ischemia in the flap region as is done in classical flap delay.…”

Determination of a Perfusion Threshold in Experimental Perforator Flap Surgery Using Indocyanine Green Angiography

“…1). 17 The cranial and caudal borders of the flap were at the level of the tip of the xiphoid and anterior superior iliac spines, respectively. The flap was raised from lateral to medial at a level deep to the panniculus carnosus, with care taken during dissection of the identified perforator.…”

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

“…However, if the flap is nourished by only one perforator vessel, distal end necrosis can occur due to insufficient blood supply, oxidative stress, and cells apoptosis (Mohan, Zhu, Wang, Vijayasekaran, & Saint‐Cyr, 2016; Wang et al, 2019a; Wang et al, 2019b). Numerous measures have been developed to improve the survival of a flap with multiple vascular territories, such as transposition of a main vascular pedicle (Ding et al, 2017; Wang et al, 2019c), injection of angiogenic growth factors (Akimoto et al, 2013; Aksakal et al, 2016; Tao et al, 2016a), vascular delay (Lineaweaver et al, 2004; Mao et al, 2019; Seyhan, Deniz, Borman, Ulusal, & Cağlar, 2010), and use of venous superdrainage or arterial supercharging (Hallock & Rice, 2005; Park, Cho, Imanishi, & Chang, 2018; Mao et al, 2019; Xin, Luan, Mu, & Mu, 2013; Yi et al, 2017).…”