title: The influence of diabetes mellitus on survival of abdominal perforator flaps: an experimental study in rats with slowly induced diabetes mellitus.
abstract: BACKGROUND
  Lower limb ulcers are a major source of morbidity and mortality in diabetic patients. Surgical coverage of these wounds is fraught with a high complication rate. Although clinically perforator flaps lead to good results in diabetic patients, there is little experimental data to support this finding.
  
  
  METHODS
  A total of 60 Wistar rats were randomly assigned either to the diabetic (n = 30) or control (n = 30) group. Diabetes was induced by streptozotocin injection at 50 mg/kg body weight and was confirmed by blood glucose levels > 180 mg/dL preoperatively. In all rats, a cranial epigastric artery perforator flap was raised. At postoperative day 7, all flaps were raised, photographed by digital planimetry, and analyzed histologically.
  
  
  RESULTS
  Mean glycemic levels preoperatively were 207.8 ± 16 in the diabetic group and 82.8 ± 5.1 in the control group (p < 0.05). Ninety percent of the flaps survived completely in the control group, compared with 66.7% in the diabetic group (p < 0.05). The mean flap survival area was lower in the diabetic group (83.3 ± 16.5%) than in the control group (96 ± 4%). There were significantly more perioperative complications in the diabetic group (46.7%) than in the control group (16.7%), but these did not affect flap survival. Superficial ulceration appeared only in the diabetic group as a complication.
  
  
  CONCLUSIONS
  Perforator flaps can be successfully used for coverage of cutaneous defects in a rat diabetic model. These flaps show higher complication rates in diabetic versus nondiabetic animals; however, this complication rate has little influence on flap survival.
authors.affiliation: Department of Plastic Surgery, Clinical Emergency County Hospital Brasov, Brasov, Romania.
authors.forename: Bogdan Ionut
authors.initials: BI
authors.lastname: Baldea
authors.affiliation: Center of Experimental Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj Napoca, Romania.
authors.forename: Septimiu
authors.initials: S
authors.lastname: Toader
authors.affiliation: Department of Clinical Endocrinology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania.
authors.forename: Pavel
authors.initials: P
authors.lastname: Orbai
authors.affiliation: Department of Plastic Surgery, Children's Emergency Hospital Cluj Napoca, Cluj Napoca, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Barsan
authors.affiliation: University Hospital "Inselspital" and University of Berne, Bern, Switzerland.
authors.forename: Radu
authors.initials: R
authors.lastname: Olariu
authors.affiliation: Department of Plastic Surgery, Clinical Emergency County Hospital Brasov, Brasov, Romania.
authors.forename: Dan Ovidiu
authors.initials: DO
authors.lastname: Grigorescu
authors.affiliation: Department of Pathology, Clinical Emergency County Hospital Brasov, Brasov, Romania.
authors.forename: Marius
authors.initials: M
authors.lastname: Penciu
authors.affiliation: Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania.
authors.forename: Andras Laszlo
authors.initials: AL
authors.lastname: Nagy
authors.affiliation: Department of Plastic Surgery, Clinical Recovery Hospital Cluj Napoca, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Cluj, Romania.
authors.forename: Alexandru Valentin
authors.initials: AV
authors.lastname: Georgescu
mesh_terms: D000818:Animals; D020405:Dermis / Q000473:pathology; D003921:Diabetes Mellitus, Experimental / Q000473:pathology / Q000503:physiopathology*; D010179:Pancreas / Q000473:pathology; D061525:Perforator Flap / Q000009:adverse effects; D011897:Random Allocation; D017208:Rats, Wistar; D012883:Skin Ulcer / Q000473:pathology / Q000503:physiopathology; D014022:Tissue Survival / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*