Supercharging Strategies for Prefabricated Flaps in a Rat Model
19 April 2018
19 March 2019
10 May 2019 (eFirst)
Background Limited survival area is an intractable problem in the clinical practice of prefabricated flaps. This study compared four strategies to find an effective method and to understand the potential mechanisms for supercharging.
Methods A prefabricated abdominal flap rodent model was prepared. Rats were randomly divided into five groups (n = 6/group). (A) Control group: prefabricated right side femoral vessels. Based on group A, various prefabricated vessels were added; (B) proximal venous supercharging group: right side superficial inferior epigastric vein (SIEV); (C) proximal arterial supercharging group: right side superficial inferior epigastric artery (SIEA); (D) distal venous supercharging group: left side SIEV; and (E) distal arterial supercharging group: left side SIEA. Macroscopic analysis, near-infrared fluorescence imaging, and microscopy were used to analyze the survival area, fluorescence area, and capillary density.
Results No significant differences in survival areas were found among supercharging groups (B–E), which were larger than in the control group. Near-infrared fluorescence imaging showed the areas of control and venous supercharging groups (A, B, and D) were smaller than in arterial groups (C and E). Capillary density areas in the right part of the flap in proximal supercharging groups (B and C) and left part of the flap in distal supercharging groups (D and E) were all greater than group A, with no significant differences among the other groups.
Conclusion Enhanced neovascularization is a useful supercharging strategy. Both arterial and venous vessel supercharging improved the survival area of prefabricated flaps.
* First two authors contributed equally to this study.
- 1 Yao ST. Vascular implantation into skin flap: experimental study and clinical application: a preliminary report. Plast Reconstr Surg 1981; 68 (03) 404-410
- 2 Li JN, Hu Y. A review of the experimental study and clinical application of the prefabricated flap. Eur J Plast Surg 2001; 24: 271-274
- 3 Lazzeri D, Su W, Qian Y. , et al. Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing. J Reconstr Microsurg 2013; 29 (04) 255-262
- 4 Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103 (03) 808-820
- 5 Li GS, Zan T, Li QF. , et al. Internal mammary artery perforator-supercharged prefabricated cervicothoracic flap for face and neck reconstruction. Ann Plast Surg 2015; 75 (01) 29-33
- 6 Xu H, Zhang Z, Tao W. , et al. Ex vivo delay: A novel approach to increase prefabricated flaps survival rate. J Reconstr Microsurg 2016; 32 (08) 632-638
- 7 Chang H, Minn KW, Imanishi N, Minabe T, Nakajima H. Effect of venous superdrainage on a four-territory skin flap survival in rats. Plast Reconstr Surg 2007; 119 (07) 2046-2051
- 8 Chang H, Nobuaki I, Minabe T, Nakajima H. Comparison of three different supercharging procedures in a rat skin flap model. Plast Reconstr Surg 2004; 113 (01) 277-283
- 9 Chow SP, Chen DZ, Gu YD. The significance of venous drainage in free flap transfer. Plast Reconstr Surg 1993; 91 (04) 713-715
- 10 Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg 2009; 124 (6, Suppl): e340-e350
- 11 Xu H, Feng S, Xia Y. , et al. Prefabricated flaps: identification of microcirculation structure and supercharging technique improving survival area. J Reconstr Microsurg 2017; 33 (02) 112-117
- 12 Hallock GG, Rice DC. Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model. Plast Reconstr Surg 2005; 116 (02) 551-555 , discussion 556
- 13 Sasaki GH, Pang CY. Hemodynamics and viability of acute neurovascular island skin flaps in rats. Plast Reconstr Surg 1980; 65 (02) 152-158