Investigating the Impact of Flap Overdesign on Viability

Abstract

Background Partial or complete flap necrosis is a detrimental outcome complicating reconstructive surgery. The purpose of this study was to evaluate the impact of flap overdesign on viability in the rat model.

Methods Forty Sprague-Dawley rats were equally divided into four groups receiving flaps of varying length-to-width ratios: 2:1, 3:1, 4:1, and 5:1. All animals had caudally based, modified McFarlane-style flap created. Areas of survival were assessed 14 days postoperatively and compared among groups using one-way analysis of variance.

Results The mean areas of flap survival were 8.0 ± 0.0 cm², 7.8 ± 1.1 cm², 8.3 ± 1.1 cm², and 8.1 ± 1.5 cm² for the 2:1, 3:1, 4:1, and 5:1 length-to-width ratio groups, respectively. There were no statistically significant differences in mean areas of flap survival among groups (p > 0.05).

Conclusion Flap overdesign does not increase the risk of flap necrosis in a random-pattern flap.

Keywords

flap - overdesign - flap necrosis - viability - reconstructive surgery - tissue defect

• References

• 1 Milton SH. Pedicled skin-flaps: the fallacy of the length: width ratio. Br J Surg 1970; 57 (07) 502-508
• 2 National Research Council of the National Academies. NIH Guide for the Care and Use of Laboratory Animals. 8th ed. Washington, DC: The National Academies Press; 2011
• 3 Dunn RM, Mancoll J. Flap models in the rat: a review and reappraisal. Plast Reconstr Surg 1992; 90 (02) 319-328
• 4 McFarlane RM, Deyoung G, Henry RA. The design of a pedicle flap in the rat to study necrosis and its prevention. Plast Reconstr Surg 1965; 35: 177-182
• 5 van Adrichem LN, Hoegen R, Hovius SE. , et al. The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat. Plast Reconstr Surg 1996; 97 (01) 86-96
• 6 Baker S. Local Flaps in Facial Reconstruction. 2nd ed. Philadelphia, PA: Mosby, Elsevier; 2007
• 7 Cutting C. Critical closing and perfusion pressures in flap survival. Ann Plast Surg 1982; 9 (06) 524
• 8 Hoopes JE, Im MJ. Skin flap necrosis in guinea pigs: limitation of glucose supply and accumulation of lactate. Plast Reconstr Surg 1978; 61 (05) 748-752
• 9 Im MJ, Su CT, Hoopes JE, Anthenelli RM. Skin-flap metabolism in rats: oxygen consumption and lactate production. Plast Reconstr Surg 1983; 71 (05) 685-688
• 10 Jurell G, Fredholm BB. Early changes in ATP and cyclic AMP levels in experimental critical skin flaps. Acta Physiol Scand 1981; 113 (01) 33-36