Effect of recipient arterial blood inflow on free flap survival area.
BACKGROUND
The influence of using different recipient arteries on free flap survival area has not been well studied. The purpose of the authors' present study was to compare the survival areas of free flaps transferred to different recipient arteries with different blood inflow and to investigate the vascular structural changes in the flaps.


METHODS
The authors developed a free three-territory flap model on the back of a rat. This three-territory flap was elevated based on the thoracodorsal vessels, which were dissected to the axillary vessels. In group 1, the control group (n = 16), the flap was transferred to the abdominal skin defect as a pedicled flap after 60 minutes of clamp ischemia. Groups 2 (n = 24) and 3 (n = 24) were free flap models that were transferred to different recipient vessels. The axillary vessels were anastomosed to the common carotid artery and the external jugular vein in group 2, and to the femoral vessels in group 3. On day 5, evaluation of the survival area of the flap, whole-body angiography, and measurement of arterial inflow to the flap were performed.


RESULTS
The greatest mean flap survival was seen in group 2 (94.3 percent). The differences between groups 1 and 2 and groups 2 and 3 were statistically significant. Angiographic studies demonstrated that the second choke zone in group 2 dilated extensively, but in groups 1 and 3, the second choke zone dilated only slightly or remained unopened.


CONCLUSIONS
The results suggest that augmenting the arterial inflow of a free flap could open the second choke zone and improve flap survival area.
Miyamoto
Shimpei
S
Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine.
Minabe
Toshiharu
T
Harii
Kiyonori
K
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D000792:Angiography; D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004195:Disease Models, Animal; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D016038:Skin Transplantation / Q000502:physiology*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome