A Microvascular Anastomosis Model for Transferring the Pedicles of Perforator Flaps with a Wedge Resection

Project no. 22321 · Status: Kapanmış (Yayın bekleniyor) · 2021

Summary

Several techniques can be used to repair soft tissue defects. Higher up the reconstructive ladder, we are seeing free flaps and perforator flaps replacing random or axial pedicled flaps in the recent decades. Although technically more demanding and time consuming, these flaps allow reconstructive surgeons to repair a tissue defect in a functionally and aesthetically more acceptable manner.Among these flaps, the perforator flaps are the newest, and maybe the most versatile as these flaps can be based on a skin perforator system virtually scattered around the integument. A so-called haute couture reconstruction, made for the said patient, and the said defect can be planned. However, some problems may arise while planning a perforator flap such as a short pedicle, a perforator not originating from an expected mother vessel, or originating from a critical vessel system crucial for the circulation of the extremity. If those concerns arise, a free flap is generally planned from afar which results in a pret-a-porter type reconstruction.In this experimental study we devised a technique to reposition a perforator on a mother vessel system to overcome a short pedicle, or on a more convenient vessel system altogether. The perforator is rooted from its source vessel as a wedge, and subsequently transferred to another position and anastomosed in an end-to-side wedge fashion. The donor wedge was repaired primarily while at the recipient vessel, a partial transection was made and the perforator is re-rooted. This way most of the problems encountered with perforator flaps can be overcome.Epigastric vessel perforator based inguinal fat pad flaps are elevated in 21 rats which were randomly divided into three groups with seven rats each. In group 1, epigastric artery was rooted from the femoral artery and transported distally (1 cm) and re-rooted with 11-0 polyethylene sutures. In group 2, epigastric artery was rooted from the femoral artery and re-rooted to the same position with 11-0 polyethylene sutures. In the control group (Group 3), the epigastric free flap was made in the classical fashion; the flap is elevated from femoral vascular system and reinserted to the same vascular system with an end-to-end anastomosis with 10-0 polyethylene sutures. Following 14 days of follow-up, the rats are sacrificed, fat pads and vascular trees including femoral and epigastric vessels were harvested to be macroscopically examined for vascular patency and immunohistochemical assessments.No significant difference was found between groups regarding anastomosis patency. In the histopathologic assessment for inflammation, ischemia, collagen deposition, and extracellular matrix the study groups were found to be significantly better than the control group. We think that this difference as a result of utilizing the so-called super-microsurgery techniques (manipulating vessels with a diameter smaller than 0.3 mm) and instruments, as well as thinner suture materials.

View details