Surface enlargement of a new arterialised venous flap by the surgical delay method
Abstract
Background/Aim. The delay method is a surgical, pharmacological and combined method that includes two or more time separated phases, which gives bigger flap surface. In our research we explored the possibility of flap surface enlargement in a new arterialised venous flap (AVF) on an experimental rabbit ear model by the delay surgical method. The aim of this research was to establish vitality surface of our AVF and to maintain the difference in flap vital surface between AVF flaps, with or without performing the delay surgery method. Methods. We used both ears of “Big Chinchilla” rabbits in 10 experimental male animals, divided into two groups, average weight 3–3.5 kg, and average age 8–10 months. In the first (experimental) group, a venous flap was arterialised by our method. In the second (control) group, the venous flap was arterialised 14 days after the delay surgical method. AVF surface was measured on the 1 and 14 days by the method of trapezoid rule. Results. Vital surface on our AVF experimental model was bigger than 87% of elevated flap surface after the delay surgical method. Vital surface on AVF without delay on our experimental model was bigger than 30% of elevated flap surface (p < 0.001). Conclusion. Analysis of previous experimental models on the rabbit ear, non-delayed and delayed (to enlarge flap surface) led us to conclusion that previously created experimental models of non-delayed AVF are hemodynamically negative. Our experimental non-delay AVF model is hemodynamically more positive than previously created models of non-delay AVF and provides better conditions for AVF survival and enlargement of vital flap surface of elevated flap. On the other hand, surgical delay method significantly enlarges vital surface of AFF.
References
Blair VP. The delayed transfer of long pedicle flaps in plastic surgery (face). Surg Gynecol Obstet 1921; 33: 261.
Lamberty BG, Cormack GC. Progress in flap surgery: greater anatomical understanding and increased sophistication in application. World J Surg 1990; 14(6): 776−85.
Cheng TJ, Chen YS, Tang YB. Use of a sequential two-in-one free arterialised venous flap for the simultaneous reconstruc-tion of two separate defects on the foot. Br J Plast Surg 2004; 57(7): 685−8.
Kelly JL, Eadie PA, Orr D, Al-Rawi M, O'Donnell M, Lawlor D. Prospective evaluation of outcome measures in free-flap sur-gery. J Reconstr Microsurg 2004; 20(6): 435−8; discussion 439.
Kushima H, Iwasawa M, Maruyama Y. Recovery of sensitivity in the hand after reconstruction with arterialised venous flaps. Scand J Plast Reconstr Surg Hand Surg 2002; 36(6): 362−7.
Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial in-flow through the venous system: an experimental investiga-tion. Plast Reconstr Surg 1981; 67(3): 328−34.
Voukudis T. An axial-pattern flap based on the arterialised ve-nous network: an experimental study in rats. Br J Plast Surg 1982; 35(4): 524−9.
Alexander G. Multistage type III venous flap or 'pre-arterialisation of an arterialised venous flap'. Br J Plast Surg 2001; 54(8): 734.
Nichter LS, Haines PC. Arterialized venous perfusion of composite tissue. Am J Surg 1985; 150(2): 191−6.
Krishnan KG. The venous flaps: an experimental study of the microvascular architecture, the area of perfusion and their cor-relation. Br J Plast Surg 2002; 55(4): 340−50.
Lalkovic M, Kozarski J, Panajotovic Lj, Šijan G, Djurdjevic D, Mik-ović N, et al. The new experimental design arterialized venous flap on the rabbit ear model. Acta Vet 2010; 60(5−6): 633−40.
Nichter LS, Jazayeri MA. The physiologic basis for nonconven-tional vascular perfusion. Plast Reconstr Surg 1995; 95(2): 406−12.
Noreldin AA, Fukuta K, Jackson IT. 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(1):18–22.
Woo SH, Kim SE, Lee TH, Jeong JH, Seul JH. Effects of blood flow and venous network on the survival of the arterialized venous flap. Plast Reconstr Surg 1998; 101(5): 1280−9.
Harris JR, Seikaly H, Calhoun K, Daugherty E. Effect of diameter of microvascular interposition vein grafts on vessel patency and free flap survival in the rat model. J Otolaryngol. 1999; 28(3): 152–7.
O'Toole G, MacKenzie D, Poole M. Therapeutic angiogenesis. Br J Plast Surg 2004; 57(2): 179.
Krishnan KG, Schackert G, Steinmeier R. The role of near-infrared angiography in the assessment of post-operative venous con-gestion in random pattern, pedicled island and free flaps. Br J Plast Surg 2005; 58(3): 330−8.
Adanali G, Seyhan T, Turegun M, Senen D, Sensoz O. Effects of different vascular patterns and the delay phenomenon on rat ventral island flap viability. Ann Plast Surg 2002; 48(6): 660−4.
Byun JS, Constantinescu MA, Lee WP, May JW Jr. Effects of delay procedures on vasculature and survival of arterialized venous flaps: an experimental study in rabbits. Plast Reconstr Surg 1995; 96(7): 1650−9.
Cho BC, Lee MS, Lee JH, Byun JS, Baik BS. The effects of surgi-cal and chemical delay procedures on the survival of arterial-ized venous flaps in rabbits. Plast Reconstr Surg 1998; 102(4): 1134−43.
Moshammer HE, Schwarzl FX, Haas FM, Maechler H, Pierer G, Wiltgen M, et al. Retrograde arterialized venous flap: an ex-perimental study. Microsurgery 2003; 23(2): 130−4.
Baser NT, Silistreli OK, Sisman N, Oztan Y. Effects of surgical or chemical delaying procedures on the survival of proximal pre-dicled venous island flaps: an experimental study in rats. Scand J Plast Reconstr Surg Hand Surg 2005; 39(4): 197−203.
Cutting C, Bardach J, Rosewall D. Skin flap delay procedures: proximal delay versus distal delay. Ann Plast Surg 1980; 4(4): 293−6.
Sano K, Hallock GG, Rice DC.Venous "supercharging" aug-ments survival of the delayed rat TRAM flap. Ann Plast Surg 2003; 51(4): 398−402.
Daniel RK, Kerrigan CL. Principles and Physiology of Skin Flap Surgery. In: McCarthy JG, editor. Plastic Surgery. Philadelphia: WB Saunders Company; 1990. p. 1314−8.
Pittet B, Quinodoz P, Alizadeh N, Schlaudraff KU, Mahajan AL. Optimizing the arterialized venous flap. Plast Reconstr Surg 2008; 122(6): 1681−9.