Is It Possible to Selectively Destroy the Vessels of the Territories To Be Captured for Strategic Transfer of Angiosomes?

Ligating the source vessels of the angiosomes to be captured has been shown to be an effective means of flap delay. In an effort to further decrease the morbidity of this procedure, the authors aimed to reduce the number of vessels interfering with successful transfer of angiosomes by comparing the outcomes of selective desiccation of the perforator(s) in different combinations, based on comprehension of the vascular architecture.

Eighteen rabbits were divided into four groups in which different combinations of vessels supplying the angiosomes to be captured were percutaneously desiccated with radiofrequency (RF). After a delay period of 2 weeks, sequential four-territory cutaneous island flaps pedicled on the superficial inferior epigastric vessels were elevated, and viability was assessed at the first week.

A comparison of results yielded a statistically insignificant difference (p = 0.521) among all of the groups, and selective desiccation of the perforator(s) was found to be as efficient as interference with all vascular sources other than the pedicle.

Selective division of only the pedicle supplying the third territory of a sequential four-territory flap had the same delay effect as division of two or all three pedicles spanned. Selective desiccation of the perforator(s) in a strategic manner is a minimally invasive, easy to perform method, and would further promote strategic transfer of angiosomes.