Is Bed Isolation Necessary During Flap Prefabrication? An Experimental Study in Rats

Mutaf, Mehmet; Tasaki, Yukihiro; Fujii, Tohru

doi:10.1097/00000637-199410000-00006

Cited by 12 publications

(7 citation statements)

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“…Sham-operated animals did not undergo any changes in perfusion, providing evidence that the alteration of the circulation in the rat island flap was due only to the flap surgery. Similar to our results, Mutaf et al 12 showed an increase in proximal flap vessel architecture and perfusion, and a reduction in the circulatory system in the distal parts, after preparation of an island groin flap.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of Total vs. Regional Blood Perfusion with a Laser Doppler Imaging System in the Rat Epigastric Flap

Fitzal

Valentini²,

Worseg³

et al. 2001

J reconstr Microsurg

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Monitoring systems to measure flap survival are either invasive, touch the surface of the tissue, or have problems in reproducibility. The authors sought to determine the efficacy of a laser Doppler imaging (LDI) system to measure perfusion in a myocutaneous flap, by producing a two-dimensional picture of the flap without touching the surface. They compared total flap perfusion with perfusion in selected areas of interest after flap surgery. The perfusion in the left groin of Sprague-Dawley rats was measured before and after surface rubbing, skin injury, and during different lighting conditions. The perfusion of the epigastric flap before and over a period of 60 min after elevation was measured, and values were compared to pre-surgical values and to sham-operated animals. They determined the differences between single and running-suture techniques after flap surgery, as well as between venous and/or arterial occlusion. Surface rubbing, skin injury, and light influenced the LDI image. After flap elevation, total flap perfusion remained stable, while the distal area (area 8, n = 7) of the flap showed a statistically significant decrease in perfusion (71 +/- 5.9 vs. 92 +/- 9.5 percent perfusion units--PU; p < .05). The proximal areas (1 to 3, n = 7) of the flap had a higher perfusion at 60 min after flap surgery, compared with sham-operated (n = 8) animals (118 +/- 12.5 vs. 97 +/- 10.4 percent PU; p < .05). The running-suture technique was followed by decreased perfusion on the peripheral side of the flap, compared with the single-suture technique (73.7 +/- 9.2 vs. 99.2 +/- 4.9 percent PU; n = 2). The LDI was able to visualize venous and/or arterial occlusion after flap surgery. Under standardized circumstances (light, temperature), the LDI was efficient in measuring regional flap circulation experimentally. While total flap perfusion after flap surgery remained stable, perfusion in the distal flap decreased significantly.

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Section: Discussionsupporting

confidence: 92%

Evaluation of Total vs. Regional Blood Perfusion with a Laser Doppler Imaging System in the Rat Epigastric Flap

Fitzal

Valentini²,

Worseg³

et al. 2001

J reconstr Microsurg

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“…The aim of this procedure is preventing neovascularisation, which can occur from bed towards implant, and encouraging neovascularisation only from the vascular carrier. Although it was proved that isolation with a silicone sheet can produce vascularity, there were no differences in survival between isolated and non-isolated groups (7,10). Furthermore, the increase in vascularity is not a result of isolation of the bed but is a process directly induced by silicone itself.…”

Section: Discussionmentioning

confidence: 95%

“…Silicone sheet can also cause complications such as seroma, infection, and eventually exposure of the silicone sheet. All these complications may produce adverse effect in this type of study (10). In our study, the implants were placed on the intact muscle fascia, which is a barrier to neovascularisation.…”

Section: Discussionmentioning

confidence: 99%

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Tissue Engineering of High Density Porous Polyethylene Implant for Three-Dimensional Reconstruction: An Experimental Study

Can

2000

Scandinavian Journal of Plastic and Reconstructive Surgery and

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Three-dimensional defects have been reconstructed with carved and remodelled frameworks wrapped within vascular carriers. If sufficient vascular penetration can be established without any change in the size and shape of an implant, it will be possible to cover it with a skin graft and aesthetically important fine details can be obtained. To achieve this, we first prefabricated high-density porous polyethylene implant in rabbits. Secondly, we applied full-thickness skin grafts over the anterior surface of the prefabricated implant. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally. A total of 10 implants were prefabricated and then grafted in five rabbits. The implants were evaluated by perfusion scintigraphy and histological examination. Results showed that the implants were invaded by fibroneo-vascular tissue, and that this tissue, which can be transferred as a pedicled or a free flap, was sufficient to sustain a skin graft.

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“…For similar reasons, one can suggest that the bed should be isolated in flap prefabrication. Although the bed isolation technique in flap prefabrication is still controversial, 31 it is believed that bed isolation procedures may improve the neovascularization of the prefabricated flaps either by a surgical delay mechanism or by orienting the angiogenesis solely to the flap. In the present study, it is assumed that flap prefabrication with the IAC may cause the bed isolation effect in the early stage, and then act as a vascular carrier in the late stage.…”

Section: Discussionmentioning

confidence: 99%

Integra Acellular Collagen as a Vascular Carrier for Skin Flap Prefabrication in Rats

Yan

Black²,

Jones³

et al. 2011

Annals of Plastic Surgery

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In this study, the feasibility of Integra acellular collagen used as a vascular carrier in skin flap prefabrication was examined. In all, 20 Sprague--Dawley rats were randomly divided into 3 groups. The saphenous vascular bundle was used as the vascular carrier. In group 1 (n = 8), an arteriovenous fistula was made by anastomosis of distal saphenous artery and vein. An Integra patch (2 × 3 cm²) was placed underneath the vascular bundle. In group 2 (n = 6), an Integra patch was placed on the top of the saphenous vessels, which remained intact. In group 3 (n = 6), an arteriovenous fistula was made without Integra implant. Two weeks after the initial management, a skin flap (2 × 3 cm² in size) was raised and replaced in each group. The survival of the flaps and histology were evaluated at 7 days after flap replacement. The results showed that the average survival area in group 1 was 98% ± 2%. No flap survival was observed in group 2. The mean survival area in group 3 was 29% ± 6%. The differences among all 3 groups were significant (P < 0.05). Although the mean survival area in group 3 was significantly lower than that in group 1 (P < 0.001), it was significantly higher than that in group 2. Histology showed that the Integra patch was incorporated into the adjacent connective tissue, and increased amounts of neovascularization were seen between the collagenous sheets and dermis in group 1. In conclusion, this study demonstrated that Integra acellular collagen can incorporate into the adjacent tissue as a vascular carrier and induce angiogenesis in flap prefabrication. This biomaterial can provide a scaffold for supporting and enhancing the survival of a vascular prefabricated skin flap. The results indicate that this material is an ideal biomaterial for flap prefabrication and may be used for this clinical purpose in the future.

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Is Bed Isolation Necessary During Flap Prefabrication? An Experimental Study in Rats

Cited by 12 publications

References 0 publications

Evaluation of Total vs. Regional Blood Perfusion with a Laser Doppler Imaging System in the Rat Epigastric Flap

Evaluation of Total vs. Regional Blood Perfusion with a Laser Doppler Imaging System in the Rat Epigastric Flap

Tissue Engineering of High Density Porous Polyethylene Implant for Three-Dimensional Reconstruction: An Experimental Study

Integra Acellular Collagen as a Vascular Carrier for Skin Flap Prefabrication in Rats

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