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J Reconstr Microsurg 2022; 38(09): 703-710
DOI: 10.1055/s-0042-1744271
Original Article

An Innovative and Economical Device for Ischemic Preconditioning of the Forehead Flap Prior to Pedicle Division: A Comparative Study

Wentian Xiao
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Sally Ng
2   Department of Plastic Surgery, The Austin Hospital, Melbourne, Australia
,
Hua Li
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Peiru Min
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Shaoqing Feng
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Weijie Su
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Yixin Zhang
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations Funding Dr. Hua Li, Dr. Sally Ng, Dr. Peiru Min, Dr. Shaoqing Feng, Dr. Weijie Su, Dr. Wentian Xiao, and Dr. Yixin Zhang report all support from National Natural Science Foundation of China; Grant number: 81772098, Scientific research foundation of Shanghai Municipal Commission of Health and Family Planning; Grant number: 20154Y0023, Outstanding Professional and Technical Leader Program of the Shanghai Municipal Science and Technology Commission; Grant number: 18XD1423700.
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Abstract

Background Ischemic preconditioning of the forehead flap prior to pedicle division helps to improve angiogenesis. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. However, the severe pain and unstable blocking effect influenced the preconditioning process. In this study, we described an innovative device designed for ischemic preconditioning and compared its efficacy with the clamped rubber band.

Methods The device consists of a self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion for ischemic preconditioning. This device and the standard clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared.

Results A total of 20 forehead flaps were included. The cable tie had less incidence of loosening (7.7% vs. 16.6%, p < 0.05) and maintained the pressure more effectively. The pain score for the nylon cable tie was significantly lower than the clamped rubber band (4.25 ± 1.02 vs. 6.75 ± 1.12, p < 0.05), especially for 10 pediatric patients (4.50 ± 0.85 vs. 8.10 ± 1.20, p < 0.01). All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications.

Conclusion Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, we recommend using the nylon cable tie as the preferred device for ischemic preconditioning of the forehead flap.

Keywords

forehead flap - ischemic preconditioning - pedicle division - pedicle clamping device - nasal reconstruction

Authors' Contributions

Y.Z. and W.S. were the director and supervisor of this study, and offered advice on the study. W.X. and S.N. wrote and revised the manuscript, and should be considered as co-first authors. H.L., P.M., and S.F. acted as co-surgeons.


Wentian Xiao and Sally Ng contributed equally to this work and should be considered as co-first authors.




Publication History

Received: 11 August 2021

Accepted: 30 January 2022

Article published online:
15 March 2022

© 2022. Thieme. All rights reserved.

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