Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xue Yuan Road, Lu Cheng District, Wenzhou 325000 China.
Department of Hand and Plastic Surgery, Wuxi 9th People's Hospital, Wuxi, China.
J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):188-193. doi: 10.1016/j.bjps.2018.10.005. Epub 2018 Nov 2.
Necrosis of propeller flaps is a problem in clinical practice. This study was performed to investigate the effects of pedicle torsion on dynamic perforasome survival using a multiterritory perforator flap model in rats.
Intercostal artery perforator flaps (IC flaps) containing two adjacent dynamic perforasomes were applied to both sides of the dorsum in 15 rats. The IC vessels were dissected carefully under 10 × magnification. A 360° arc of pedicle torsion was applied to the right IC flaps, which comprised the rotary group. Left IC flaps were used as controls. Flap perfusion, viability, and angiography were compared between the two groups.
Sodium fluorescein angiography showed that there was blood supply to the flap in both groups on postoperative day (POD) 1, and laser Doppler images indicated that flap perfusion increased daily after surgery. The differences in perfusion of dynamic perforasomes between the two groups were not significant. The mean survival rate of the rotary group was not significantly different from that of the control group (98.94 ± 1.24% versus 99.03 ± 1.86%, respectively, p > 0.05) on POD 7. Angiography showed that dilated choke vessels connected the three perforasomes in both groups.
The 360° arc of pedicle torsion had no detrimental effect on dynamic perforasome perfusion or survival in a multiterritory perforator flap model after meticulous surgical dissection of the pedicle in this study. The dilated choke vessel connected adjacent perforasomes, and the dynamic perforasome survival still adhered to the perforasome theory after pedicle torsion.
皮瓣坏死是临床实践中的一个问题。本研究旨在通过大鼠多区域穿支皮瓣模型研究蒂扭转对动力穿支体存活的影响。
15 只大鼠的背部两侧应用肋间动脉穿支皮瓣（IC 皮瓣），包含两个相邻的动力穿支体。在 10×放大倍数下仔细解剖 IC 血管。右侧 IC 皮瓣应用 360°蒂扭转弧，作为旋转组。左侧 IC 皮瓣作为对照组。比较两组皮瓣灌注、存活和血管造影情况。
术后第 1 天，两组皮瓣的钠荧光素血管造影均显示有血液供应，激光多普勒图像表明术后皮瓣灌注每天增加。两组动力穿支体的灌注差异无统计学意义。旋转组的平均存活率与对照组无显著差异（分别为 98.94±1.24%和 99.03±1.86%，p>0.05），在术后第 7 天。血管造影显示扩张的吻合血管连接两组的三个穿支体。
在本研究中，通过对蒂进行精细的手术解剖，360°蒂扭转对多区域穿支皮瓣模型中动力穿支体灌注和存活没有不利影响。扩张的吻合血管连接相邻的穿支体，蒂扭转后动力穿支体的存活仍符合穿支体理论。
