Effects of 360° Pedicle Torsion on Island Skin Flaps: Experimental Study in Rats

Abstract

This study was carried out to observe the isolated effects of pedicle torsion on island skin flaps, without further damaging the pedicle. Twelve adult male Sprague-Dawley rats, weighting 240 to 300 gr, were used, and hexagonal flaps with edges measuring 1.5 cm and pedicles measuring 1 cm in length were raised in the inguinal region. The animals were divided into two groups. In Group A, flaps were re-sutured to the donor beds without any rotation. In Group B, flaps were rotated 360 degrees, applying the same degree of torsion to their pedicles before re-suturing. After 7 days, the percentage of surviving skin areas of the flaps was determined by planimetry, and transverse sections of the flaps and pedicles were taken and evaluated in terms of signs of arterial or venous insufficiency. Statistically significant differences between the groups were determined by analyses using the multiple comparisons test. Pedicle torsion in Group B did not affect flap viability, both macroscopically and microscopically. The presented study shows that 360-degree torsion applied to the pedicle of the flap in this model had no effect on flap viability.

Are There Risk Factors for Complications of Perforator-based Propeller Flaps for Lower-extremity Reconstruction?

“…This finding accounted for the majority of venous congestion versus reduced arterial inflow we found in our series. Experimental experience [8] seems to suggest that a rotation of as much as 360°does not affect the patency of the vessels, providing that the pedicle is dissected extensively and free from all potential constrictions. It also has been stated that pedicle length is inversely proportional to the critical angle of twisting [22,26], suggesting, the longer the pedicle is, the wider a safe arc of rotation will be ( Fig.…”

The Effect of Normovolemic and Hypervolemic Hemodilution on a Perforator Flap with Twisted Pedicle Model

“…Skin flap necrosis could be attributable to insufficient arterial blood flow, but poor venous outflow may also be responsible for inadequate perfusion and consequent flap failure. 15,16 Because of the thinner wall, lower elasticity, and lower pressure in the venous system, the effects of twisting applied to the veins of the pedicle are more evident, resulting in venous insufficiency and consequent flap congestion. 17 However, there are other factors that affect flaps viability, and blood viscosity represents a key element of flap blood flow regulation.…”

Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon

“…6,7,[24][25][26] These effects have been investigated separately in flaps with axial patterned and perforator flaps, and torsion has also been shown to disrupt flap circulation through similar mechanisms. [3][4][5] Although, on the basis of clinical experience, it may be suggested that perforator flaps are more sensitive to the harmful effects of pedicle rotation, no studies comparing the durability of axial patterned and perforator flaps with pedicle rotation have been conducted.…”

“…The groin flap is supplied by the superficial epigastric artery and has been used in previous similar studies. 3,4 The posterior thigh flap possesses a musculocutaneous perforator vessel. Although this artery is small, it is not difficult to isolate with meticulous dissection, and the most important advantage over other perforator flap models is that two posterior thigh perforator-based flaps are available per animal.…”