Assessment of Tissue Perfusion and Effect of Liposuction on Abdominally Based Perforator Flaps

Introduction: There are few reports on successful breast reconstruction using abdominally based flaps at patients with previous history of abdominal liposuction. These studies evaluated the effect of abdominal liposuction on the perforators by either using microangiography in fresh cadavers or color Doppler ultrasound in patients. The aim of this study is to investigate the effect of liposuction on the perfusion of a perforator flap model using a laser Doppler spectrophotometry device.

Methodology and Material: 9 female patients (Avg. 41.7, 29-52) undergoing classical abdominoplasty were included in the study. Age, operation time, tumescent solution volume, amount of liposuction, blood pressure, oxygen saturation were recorded. A laser Doppler spectrophotometry device (02C, Oxygen to See, LEA Medizintechnik Giessen, Germany) was utilized to measure microcirculatory parameters; capillary venous oxygen saturation (CVOS), relative amount of hemoglobin (rHb), relative blood flow (Flow) and blood flow velocity (Velocity). Four zones of perfusion of DIEAP flap were marked as described by Holm et al (ref). Gridlines were drawn to further divide each zone into 6 sub-zones to provide mean values for each parameter. Measurements were taken at five different time points: before (Bas) and after tumescent solution injection (pTS), after perforator isolation (PI) and after deep (DLL) and superficial (SLL) liposuction separately.

Results: On zone 1 flow and velocity parameters were significantly lower after SLL compared with Bas values (p < 0.05). There was no statistically significant difference between PI, SLL or DLL time points regarding any of the parameters (p>0.05). On zone 2, flow after SLL was significantly lower than Bas (p < 0.05) and velocity was significantly lower after PI compared with Bas values. On zone 3, flow and velocity were both significantly lower after SLL and DLL compared with Bas values separately (p < 0.05). Velocity values were also significantly lower after PI compared with BAS as in Zone-2(p < 0.05). On zone 4, flow and velocity were both significantly lower after SLL and DLL compared with Bas values separately (p < 0.05). Velocity values were also significantly lower after PI compared with BAS as in Zone-2 and Zone-3(p < 0.05). For each abdominal zone there was no statistically significant difference, regarding the four parameters measured, after PI compared with after DLL and SLL separately (p>0.05).

Conclusions: This study demonstrates a perforator flap model for further studies and provides laser spectrophotometry values for each zone of abdominal perforator flaps. Data obtained in this study supports the zone concept previously modified by Holm et al. Furthermore, liposuction of a flap based on its perforator appears to not effect flap microcirculation.