title: The importance of a skin bridge in peripheral tissue perfusion in perforator flaps.
abstract: BACKGROUND
  Perforator flaps are increasingly used in reconstructive surgery. However, the microvascular perfusion pattern within these flaps remains essentially unknown. In perforator flaps, the importance of preserving the skin bridge at the base is still an object of debate. The authors hypothesized that dividing the skin bridge will increase peripheral tissue perfusion in islanded perforator flaps.
  
  
  METHODS
  The abdominal panniculus in patients submitted to elective abdominoplasty was used (n = 24). Flap perfusion was measured by dynamic laser-induced fluorescence videoangiography. The fluorescent dye indocyanine green was injected intravenously before and after conversion of a perforator flap with an intact skin bridge into an islanded perforator flap. To evaluate perfusion, mean pixel intensity and mean perfusion index were calculated in a control zone and in two zones in the flap.
  
  
  RESULTS
  In zone I (the most peripheral zone), surgical release of the skin bridge increased mean pixel intensity (19.1 ± 1.9 versus 24.1 ± 2.1; p < 0.001). The mean perfusion index was calculated as 7.5 ± 5.5 and 12.6 ± 6.3 before and after surgical conversion to islanded perforator flaps, respectively. In zone II (the more proximal zone), mean pixel intensity increased (from 30.8 ± 2.8 to 33.7 ± 2.3; p < 0.001) after surgical release of the skin bridge. The mean perfusion index was 18.5 ± 11.1 and 15.6 ± 6.2.
  
  
  CONCLUSIONS
  In this human experimental study, conversion of a perforator flap with a skin bridge into an islanded perforator flap increases peripheral tissue perfusion. This finding provides a physiologic basis for using islanded perforator flaps, with enhanced flap mobility and length.
authors.affiliation: Oslo, Norway From the Department of Plastic and Reconstructive Surgery and Medical Faculty, Oslo University Hospital, Oslo; and the Department of Anesthesiology, Oslo University Hospital, Ullevaal.
authors.forename: Haris
authors.initials: H
authors.lastname: Mešić
authors.forename: Knut A
authors.initials: KA
authors.lastname: Kirkebøen
authors.forename: Ravi
authors.initials: R
authors.lastname: Bains
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D013524:Surgical Flaps / Q000098:blood supply*