Percutaneous Dessication of the Perforators with Radiofrequency vs. Endoscopic Ligation for Transfer of Angiosomes

Recent studies have evolved the concept of flap delay by determining that incising the flap boundaries or raising the flap are not necessary for an effective delay, and ligating the source vessels of the angiosomes to be captured is as efficient. In order to advance this approach one step further, the authors investigated if desiccation of these pedicles with percutaneous radiofrequency (RF) would offer a simple but effective surgical means for transfer of angiosomes.

In 12 sequential four–territory cutaneous island flaps in rabbits, three vessels supplying the flap excluding the pedicle were percutaneously desiccated with RF after identification with the Doppler probe. The same vessels were ligated under direct vision via limited skin incisions in another group of 12 flaps (endoscopy equivalent). After a delay period of 2 weeks, these flaps and another group of 12 flaps without delay were elevated and the viability was assessed at the first week.

Percutaneous desiccation of the perforators with RF was found to be a reliable method comparable to ligation of the vessels under direct vision. Both techniques augmented flap viability to approximately 95% from 63% of the flap without delay.

Desiccating the vessels supplying the angiosomes to be captured percutaneously with RF would be an alternative and an easier surgical means for transfer of angiosomes.