Influence of Recipient-Bed Isolation on Survival Rates of Skin-Flap Transfer in Rats

ABSTRACT

The effect of recipient-bed isolation with artificial barriers on skin-flap survival, compared to flap transfer without bed isolation, was evaluated in a modified rat epigastric skin-flap model. The pattern of blood flow in the raised flap with a proximal axial portion and distal random portion was confirmed by laser Doppler flowmetry. Forty rats were divided into four groups. Three of the groups had one of three different artificial barriers-silicone, polypropylene, or gelatin sponge. In each of these three groups, one of the artificial barriers was placed between the flap and its recipient bed after flap replacement. The flaps without bed isolation (Group 4) were used as controls. The survival area was measured 7 days postoperatively. Results demonstrated that necrosis in the groups with silicone and polypropylene barriers was significantly higher than in the controls. Histologically, neovascularization was shown in the flaps without artificial barriers. Foreign-body reactions were observed in the flaps with bed isolation and among these, severe inflammation and congestion were seen in the flaps with polypropylene isolation. In this study, the authors demonstrated that the random portion of a rat skin flap could survive partially through imbibition of plasma and the ingrowth of new vessels from the recipient bed. This neovascularization can be prevented by recipient-bed isolation with an artificial barrier. Bed isolation with a silicone sheet is suggested for use in the study of rat skin-flap survival.

KEYWORD

Recipient-bed isolation vs. flap transfer with no bed isolation - survival rates of transfers - rat model

REFERENCES

• 1 Kerrigan C L. Skin flap failure: pathophysiology.  Plast Reconstr Surg . 1983;  72 766-777
• 2 Khouri R K, Upton J, Shaw W W. Prefabrication of composite free flaps through staged microvascular transfer: an experimental and clinical study.  Plast Reconstr Surg . 1991;  87 108-115
• 3 Chow S P, Chen D Z, Gu Y D. The significance of venous drainage in free flap transfer.  Plast Reconstr Surg . 1993;  91 713-715
• 4 Gherardini G, Lundeberg T, Matarasso A. Calcitonin gene-related peptide increases microcirculation after mechanically induced ischemia in an experimental island flap.  Ann Plast Surg . 1995;  35 178-183
• 5 Gherardini G, Evans G R, Theodorsson E. Calcitonin gene-related peptide in experimental ischemia: implication of an endogenous anti-ischemic effect.  Ann Plast Surg . 1996;  36 616-620
• 6 Machens H G, Morgan J R, Berthiaume F. Genetically modified fibroblasts induce angiogenesis in the rat epigastric island flap.  Langenbecks Arch Surg . 1998;  383 345-350
• 7 Weinzweig N, Lukash F, Weinzweig J. Topical and systemic calcium channel blockers in the prevention and treatment of microvascular spasm in a rat epigastric island skin flap model.  Ann Plast Surg . 1999;  42 320-326
• 8 Yenidunya M O, Yilmaz S. Arteriovenous fistula and skin flaps.  J Reconstr Microsurg . 1999;  15 555-562
• 9 Misholy H, Jacobs G, Reinisch J F, Puckett C L. A grid method for evaluating flap survival in rats.  Plast Reconstr Surg . 1982;  69 881-882
• 10 Dibbell D G, Hedberg J R, McCraw J B. A quantitative examination of the use of fluorescein in predicting viability of skin flaps.  Ann Plast Surg . 1979;  3 101-105
• 11 Kaufman T, Angel M F, Eichenlaub E H. The salutary effects of the bed on the survival of experimental flaps.  Ann Plast Surg . 1985;  14 64-73
• 12 Komorowska-Timek E, Chen S G, Zhang F. Prolonged perivascular use of verapamil or lidocaine decreases skin flap necrosis.  Ann Plast Surg . 1999;  43 283-288
• 13 Pu L L, Ahmed S, Thomson J G. Endothelial cell growth factor enhances musculocutaneous flap survival through the process of neovascularization.  Ann Plast Surg . 1999;  42 306-312
• 14 Zhang F, Fischer K, Komorowska-Timek E. Improvement of skin paddle survival by application of vascular endothelial growth factor in a rat TRAM flap model.  Ann Plast Surg . 2001;  46 314-320
• 15 Itoh Y. An experimental study of prefabricated flaps using silicone sheets, with reference to the vascular patternization process.  Ann Plast Surg . 1992;  28 140-146
• 16 Hom D B, Assefa G. Effects of endothelial cell growth factor on vascular compromised skin flaps.  Arch Otolaryngol Head Neck Surg . 1992;  118 624-628
• 17 Iinuma T, Sawada Y. Topical application of capsaicin and flap survival.  Br J Plast Surg . 1996;  49 319-320
• 18 Noreldin A A, Fukuta K, Jackson I T. Role of perivenous areolar tissue in the viability of venous flaps: an experimental study on the inferior epigastric venous flap of the rat.  Br J Plast Surg . 1992;  45 18-22
• 19 Angel M F, Kaufman T, Swartz W M. Studies on the nature of the flap/bed interaction in rodents. Part I. Flap survival under varying conditions.  Ann Plast Surg . 1986;  17 317-322
• 20 Mutaf M, Tasaki Y, Fujii T. Is bed isolation necessary during flap prefabrication?.  <~>An experimental study in rats. Ann Plast Surg . 1994;  33 392-400
• 21 Goldwyn R M, Lamb D L, White W L. An experimental study of large island flaps in dogs.  Plast Reconstr Surg . 1963;  31 528-536
• 22 Strauch B, Murray D E. Transfer of composite graft with immediate suture anastomosis of its vascular pedicle measuring less than 1 mm in external diameter using microsurgical techniques.  Plast Reconstr Surg . 1967;  40 325-329
• 23 Finseth F, Cutting C. An experimental neurovascular island skin flap for the study of the delay phenomenon.  Plast Reconstr Surg . 1978;  61 412-420
• 24 Padubidri A N, Browne E, Banbury J, Seimionow M. Arteriovenous cross-flow flap in rats: a novel skin flap.  Plast Reconstr Surg . 1997;  100 1218-1226
• 25 Hickerson W L, Colgin S L, Proctor K G. Regional variations of laser Doppler blood flow in ischemic skin flaps.  Plast Reconstr Surg . 1990;  86 319-326
• 26 Zhang F, Lineaweaver W C, Kao S D. Manual of Experimental Muscle Flap and Organ Transplantation Models in the Rat.  Reading: Sharpoint 1995
• 27 Dunn R M, Mancoll J. Flap models in the rat: a review and reappraisal.  Plast Reconstr Surg . 1992;  90 319-328
• 28 Finseth F, Adelberg M G. Prevention of skin flap necrosis by a course of treatment with vasodilator drugs.  Plast Reconstr Surg . 1978;  61 738-743
• 29 Falcone R E, Ruberg R L. Pharmacologic manipulation of skin flaps: lack of effect of barbiturates or nicotine.  Plast Reconstr Surg . 1980;  66 102-104
• 30 Converse J M, Uhlschmid G K, Ballantyne D L. ``Plasmatic circulation'' in skin grafts: the phase of serum imbibition.  Plast Reconstr Surg . 1969;  43 495-499
• 31 Rudolph R, Klein L. Healing processes in skin grafts.  Surg Gynecol Obstet . 1973;  136 641-654
• 32 Yim K, Lineaweaver W C, Briones R. Critical ischemia time of rat serratus anterior and gracilis muscles.  In Carraro U, Salmon S (eds.): Basic and Applied Myology: Perspectives for the 90's. Padova: Unipress 1991: 373-378
• 33 Angel M F, Kaufman T, Swartz W M. Studies on the nature of the flap/bed interaction in rodents. Part I. Flap survival under varying conditions.  Ann Plast Surg . 1986;  17 317-322
• 34 Angel M F, Ramasastry S S, Narayanan K. Studies on the nature of the flap/bed interaction in rodents. Part II. Morphological and fluorescein kinetic data.  Ann Plast Surg . 1986;  17 434-439
• 35 Oswald P, Tilgnerr A, Schumann D. The influence of postoperative vessel occlusion on the viability of free microvascular skin-fat flaps and island flaps in rats.  J Reconstr Miccrosurg . 1988;  4 403-407
• 36 Fansler R F, Taheri P, Cullinane C. Polypropylene mesh closure of the complicated abdominal wound.  Am J Surg . 1995;  170 15-18
• 37 Brandt C P, McHenry C R, Jacobs D G. Polypropylene mesh closure after emergency laparotomy: morbidity and outcome.  Surgery . 1995;  118 736-740