Effect of a nondominant perforator on multiterritory perforator flap survival in rats

Abstract

Background During flap surgery, the dominant perforator is usually selected as the pedicle. This study investigated the effect of a nondominant perforator on multiterritory perforator flap survival. Methods The deep circumflex iliac artery perforator flap (DCIA flap) and intercostal artery perforator flap (ICA flap) were performed (n = 12). Only the pedicle was different between the two flaps. The DCIA flap was based on the right and peripheral DCIA with three dynamic and two potential perforasomes. The ICA flap was based on the right and central ICA with five dynamic perforasomes. All adjacent perforators were ligated except the pedicle. On postoperative day 7, flap viability, angiography findings, and perfusion were compared. Results Even though the diameter of DCIA (mm) was larger than that of ICA (0.49 ± 0.03 vs. 0.4 ± 0.04; p < .05), the ICA flap survival rate (%) was higher than that of DCIA flap (99.5 ± 0.7 vs. 83.8 ± 3.9; p < .001). Based on a dominant perforator, a necrotic area was observed in the potential perforasomes of the DCIA flap. The choke vessels between the anatomical and dynamic perforasomes dilated postoperatively in the two flaps, whereas the others did not. The perfusion (PU) differences between the DCIA and ICA flaps in the dynamic perforasomes were nonsignificant (average, 342.4 ± 9.1 vs. 347.3 ± 7.3; p > .05). Conclusion Increasing the number of dynamic perforasomes had no effect on flap survival, even based on a nondominant perforator. And the pedicle position affected flap survival.

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).…”