title: What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?
abstract: BACKGROUND
  We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap.
  
  
  METHODS
  A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively.
  
  
  RESULTS
  Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%).
  
  
  CONCLUSIONS
  It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap.
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Tingliang
authors.initials: T
authors.lastname: Wang
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jiao
authors.initials: J
authors.lastname: Wei
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jinguang
authors.initials: J
authors.lastname: He
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.affiliation: Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jiasheng
authors.initials: J
authors.lastname: Dong
mesh_terms: D000818:Animals; D004322:Drainage / Q000379:methods; D007238:Infarction / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D061525:Perforator Flap / Q000009:adverse effects / Q000098:blood supply* / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012039:Regional Blood Flow