Does Random Pattern Skin Flap Supply Adequate Circulation to the Underlying Muscle Through Musculocutaneous Perforators by Reverse Flow? An Experimental Study

ABSTRACT

An experimental study was designed to examine whether the blood supply of the muscle would be maintained by a reverse flow from the random pattern skin flap through the musculocutaneous perforators. A flap model containing rat rectus abdominis muscle and randomly based overlying abdominal skin was designed. Sixty rats were divided into four experimental groups as follows. In group I, scintigraphy and microangiography were performed in 10 and 6 rats, respectively, immediately after flap elevation. In group II, scintigraphy and microangiography were performed in 10 and 6 rats, respectively, 2 days after flap elevation. In group III, surviving skin paddle area was evaluated in 16 rats 7 days after flap elevation. After evaluation of surviving skin paddle area, the same animals were used for microangiographic (n = 6) and scintigraphic (n = 10) studies at the same day. In group IV, histopathologic examination was done in six flap muscles each 2 and 6 weeks after flap elevation (n = 12). The mean percentage of surviving skin paddle area was 95.6 ± 6.5% on postoperative day 7. Microangiography showed progressively developed blood flow from the skin to muscle through the musculocutaneous perforators in groups II and III, respectively. The radioisotope uptake of the operated muscle was 40.9 ± 12.8% immediately after flap elevation (group I), 58.3 ± 15.6% on postoperative day 2 (group II), and 70.7 ± 25.6% on postoperative day 7 (group III). There was a significant difference only between group I and group III (p < 0.05, analysis of variance). Histopathologically prominent atrophy, lipomatoses, and fibroses were revealed at week 6. The poor circulation and viability outcomes of the muscle revealed in the study are because of immediately insufficient blood microcirculation at the distal part of the random pattern skin flap.

KEYWORDS

Random skin flap - reverse blood flow - muscle viability

REFERENCES

• 1 Cormack G C, Lamberty B G. The microcirculation. In: Cormack GC, Lamberty BG The Arterial Anatomy of Skin Flaps. 2nd ed. London; Churchill Livingstone 1994: 15-69
• 2 Yazar S, Cetinkale O, Senel O et al.. An experimental study of skin flap associated with muscle: Is muscle nourishment possible through the musculocutaneous perforators?.  Ann Plast Surg. 2000;  45 500-508
• 3 Restifo R J, Ahmed S S, Isenberg J S et al.. Timing, magnitude, and utility of surgical delay in the TRAM flap: I. Animal studies.  Plast Reconstr Surg. 1997;  99 1211-1216
• 4 Restifo R J, Ahmed S S, Rosser J et al.. TRAM flap perforator ligation and the delay phenomenon: development of an endoscopic/laparoscopic delay procedure.  Plast Reconstr Surg. 1998;  101 1503-1511
• 5 Özgentaş H E, Shenaq S, Spira M. Development of a TRAM flap model in the rat and study of vascular dominance.  Plast Reconstr Surg. 1994;  94 1012-1017
• 6 Özgentaş H E, Shenaq S, Spira M. Study of the delay phenomenon in the rat TRAM flap model.  Plast Reconstr Surg. 1994;  94 1018-1024
• 7 Kostakoğlu N, Manek S, Green C J. The development of neovascularisation in flap prefabrication with vascular implantation: an experimental study.  Br J Plast Surg. 1997;  50 428-434
• 8 Rees M J, Taylor G I. A simplified lead oxide cadaver injection technique.  Plast Reconstr Surg. 1986;  77 141-145
• 9 Boyd J B, Taylor G I, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems.  Plast Reconstr Surg. 1984;  73 1-14
• 10 Cederna P S, Chang P, Pittet-Cuenod B M et al.. The effect of the delay phenomenon on the vascularity of rabbit abdominal cutaneous island flaps.  Plast Reconstr Surg. 1997;  99 183-193
• 11 Sayman H B, Urgancıoglu I. Muscle perfusion with technetium-MIBI in lower extremity peripheral arterial diseases.  J Nucl Med. 1991;  32 1700-1703
• 12 Cetinkale O, Demir M, Sayman H B et al.. Effects of allopurinol, ibuprofen and cyclosporin A on local microcirculatory disturbances due to burn injuries.  Burns. 1997;  23 43-49
• 13 Mathes S J, Eshima I. The principles of muscle and musculocutaneous flaps. In: McCarthy JG Plastic Surgery: General Principles. Philadelphia, PA; W.B. Saunders Company 1990: 379-411
• 14 Taylor G I, Palmer J H. The vascular territories (angiosomes) of the body: experimental study and clinical applications.  Br J Plast Surg. 1987;  40 113-141
• 15 Hallock G G, Rice D C. Evidence for the efficacy of TRAM flap delay in a rat model.  Plast Reconstr Surg. 1995;  96 1351-1357
• 16 Clugston P A, Perry L C, Fisher J et al.. A rat transverse rectus abdominis musculocutaneous flap model: effects of pharmacological manipulation.  Ann Plast Surg. 1995;  34 154-160
• 17 Sasaki G H, Pang C Y. Hemodynamics and viability of acute neurovascular island skin flaps in rats.  Plast Reconstr Surg. 1980;  65 152-158
• 18 Daniel R K, Kerrigan C L. Principles and physiology of skin flap surgery. In: McCarthy JG Plastic Surgery: General Principles. Philadelphia; W.B. Saunders Company 1990: 275-328
• 19 Gosain A, Chang N, Mathes S et al.. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps.  Plast Reconstr Surg. 1990;  86 1152-1162