This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Experimental study of survival of pedicled perforator flap with flow‐through and flow‐end blood supply. BJS 2015; 102: 375-381.

Published: 17th February 2015

Authors: Y. Wang, S.‐Y. Chen, W.‐Y. Gao, J. Ding, W. Shi, X.‐L. Feng et al.

Background

Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow‐through blood supply, compared with that of a flap with a flow‐end blood supply and perforator terminal branch.

Method

Forty Sprague–Dawley rats, 20 in each group, were assigned to transfer of a superficial epigastric artery pedicle island flap with a flow‐through or flow‐end configuration of blood supply. Laser Doppler imaging was used to evaluate flap perfusion 2 h, 3 days and 5 days after surgery. The rats were killed on day 5, and lead oxide–gelatine‐enhanced flap angiography and histology with haematoxylin and eosin staining was performed. Dorsal midline tissue was excised for quantification of vascular endothelial growth factor by western blot assay.

Results

On day 5 after surgery, the flow‐through group exhibited a significantly greater mean(s.d.) flap survival area (97·8(3·5) versus 80·8(10·2) per cent; P = 0·003), microvascular density (303(19) versus 207(41) per mm²; P < 0·001) and perfusion (8·64(0·14) versus 5·95(0·14) perfusion units; P < 0·001) than the flow‐end group. The flow‐through group exhibited more angiosomes connected by dilated vascular anastomoses between the skin and subcutaneous fasciae.

Conclusion

The flow‐through blood supply improved pedicle perforator flap survival.

Surgical relevance

Perforator flap failure is mainly the result of impaired blood supply, as a flow‐end blood configuration is nourished only by the perforator terminal branch of the artery.

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