title: Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply.
abstract: BACKGROUND
  Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow-through blood supply, compared with that of a flap with a flow-end blood supply and perforator terminal branch.
  
  
  METHODS
  Forty Sprague-Dawley rats, 20 in each group, were assigned to transfer of a superficial epigastric artery pedicle island flap with a flow-through or flow-end configuration of blood supply. Laser Doppler imaging was used to evaluate flap perfusion 2 h, 3 days and 5 days after surgery. The rats were killed on day 5, and lead oxide-gelatine-enhanced flap angiography and histology with haematoxylin and eosin staining was performed. Dorsal midline tissue was excised for quantification of vascular endothelial growth factor by western blot assay.
  
  
  RESULTS
  On day 5 after surgery, the flow-through group exhibited a significantly greater mean(s.d.) flap survival area (97·8(3·5) versus 80·8(10·2) per cent; P = 0·003), microvascular density (303(19) versus 207(41) per mm(2) ; P < 0·001) and perfusion (8·64(0·14) versus 5·95(0·14) perfusion units; P < 0·001) than the flow-end group. The flow-through group exhibited more angiosomes connected by dilated vascular anastomoses between the skin and subcutaneous fasciae.
  
  
  CONCLUSIONS
  The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.
authors.affiliation: Department of Hand and Plastic Surgery, Second Affiliated Hospital and Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: S-Y
authors.initials: SY
authors.lastname: Chen
authors.forename: W-Y
authors.initials: WY
authors.lastname: Gao
authors.forename: J
authors.initials: J
authors.lastname: Ding
authors.forename: W
authors.initials: W
authors.lastname: Shi
authors.forename: X-L
authors.initials: XL
authors.lastname: Feng
authors.forename: X-Y
authors.initials: XY
authors.lastname: Tao
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: D-S
authors.initials: DS
authors.lastname: Ling
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D019074:Epigastric Arteries / Q000601:surgery; D006085:Graft Survival / Q000502:physiology*; D007083:Iliac Artery / Q000473:pathology; D017078:Laser-Doppler Flowmetry; D008297:Male; D055806:Microvessels / Q000033:anatomy & histology; D009336:Necrosis; D017207:Rats, Sprague-Dawley; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D042461:Vascular Endothelial Growth Factor A