Download PDF
J Reconstr Microsurg 2016; 32(08): 632-638
DOI: 10.1055/s-0036-1584809
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ex Vivo Delay: A Novel Approach to Increase Prefabricated Flaps Survival Rate

Heng Xu
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Zheng Zhang
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Wei Tao
2   The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University School of Mechanical Engineering, Shanghai, China
,
Zvi Steinberger
3   Department of Orthopaedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
,
Hua Li
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
L. Scott Levin
4   Department of Orthopedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
,
Yong Fang
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Yi Xin Zhang
1   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations
Further Information

Publication History

28 March 2016

20 May 2016

Publication Date:
01 July 2016 (online)

    Permissions and Reprints

Abstract

Background Limited flap survival area is the main disadvantage of prefabricated flaps. To deal with this problem, surgical delay is the common method to achieve a better prognosis. This method requires multiple surgeries with the known associated burdens. We have developed a new strategy, ex vivo delay, utilizing the pathophysiology of surgical delay while avoiding the need for multiple surgeries.

Methods We created a rodent animal model utilizing a two-stage operation of a prefabricated abdominal flap. The rats were randomly divided into three groups (n = 6 per group): group A, the control group (no intervention), group B, delayed by the ex-vivo delay device, and group C, delayed using surgical delay technique. Data were collected according to macroscopic analysis, near-infrared fluorescence imaging, and capillary densities.

Results According to the macroscopic analysis, groups B and C had a significantly larger flap survival area compared with group A, but group B had a significantly smaller survival area than group C. The near-infrared fluorescence imaging showed the perfusion areas of group B and C to be larger than that of group A. Histologically, groups B and C had a significantly higher capillary density than group A. The vessel caliber in group C was larger than that of groups A and B.

Conclusions The ex vivo delay strategy successfully increased flap survival area. This strategy worked by establishing ischemia and enhancing neovascularization. Further improvements in the surgical technique could produce outcomes similar to those seen with surgical delay.

Keywords

prefabricated flap - survival area - ex vivo delay

Note

Heng Xu and Zheng Zhang contribute equally to this study.


 

  • References

  • 1 Li JN, Hu Y. A review of the experimental study and clinical application of the prefabricated flap. Eur J Plast Surg 2001; 24: 271-274
    CrossrefPubMedGoogle Scholar
  • 2 Leighton WD, Russel RC, Marcus DE. Experimental expansion of cutaneous and myocutaneous free flap donor sites: Anatomical, physiological, and histological changes. Plast Surg Forum 9: 262
    PubMedGoogle Scholar
  • 3 Taylor GI, Corlett RJ, Caddy CM, Zelt RG. An anatomic review of the delay phenomenon: II. Clinical applications. Plast Reconstr Surg 1992; 89 (3) 408-416 , discussion 417–418
    CrossrefPubMedGoogle Scholar
  • 4 Maitz PK, Pribaz JJ, Duffy FJ, Hergrueter CA. The value of the delay phenomenon in flap prefabrication: an experimental study in rabbits. Br J Plast Surg 1994; 47 (3) 149-154
    CrossrefPubMedGoogle Scholar
  • 5 de Figueiredo JC, Naufal RR, Claro de Oliveira Jr F, Arias V, Bueno Pereira PR, Inaco Cirino LM. Prefabricated flap composed by skin and terminal gastromental vessels. Experimental study in rabbits. J Plast Reconstr Aesthet Surg 2010; 63 (6) e525-e528
    CrossrefPubMedGoogle Scholar
  • 6 Lazzeri D, Su W, Qian Y , et al. Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing. J Reconstr Microsurg 2013; 29 (4) 255-262
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg 2009; 124 (6, Suppl): e340-e350
    CrossrefPubMedGoogle Scholar
  • 8 Abbase EA, Shenaq SM, Spira M, el-Falaky MH. Prefabricated flaps: experimental and clinical review. Plast Reconstr Surg 1995; 96 (5) 1218-1225
    CrossrefPubMedGoogle Scholar
  • 9 Suzuki S, Isshiki N, Ohtsuka M, Maeda T. Experimental study on “delay” phenomenon in relation to flap width and ischaemia. Br J Plast Surg 1988; 41 (4) 389-394
    CrossrefPubMedGoogle Scholar
  • 10 Cinpolat A, Bektas G, Coskunfirat N, Rizvanovic Z, Coskunfirat OK. Comparing various surgical delay methods with ischemic preconditioning in the rat TRAM flap model. J Reconstr Microsurg 2014; 30 (5) 335-342
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 De Saedeleer CJ, Copetti T, Porporato PE, Verrax J, Feron O, Sonveaux P. Lactate activates HIF-1 in oxidative but not in Warburg-phenotype human tumor cells. PLoS ONE 2012; 7 (10) e46571
    CrossrefPubMedGoogle Scholar
  • 12 De Bock K, Georgiadou M, Schoors S , et al. Role of PFKFB3-driven glycolysis in vessel sprouting. Cell 2013; 154 (3) 651-663
    CrossrefPubMedGoogle Scholar
  • 13 Callegari PR, Taylor GI, Caddy CM, Minabe T. An anatomic review of the delay phenomenon: I. Experimental studies. Plast Reconstr Surg 1992; 89 (3) 397-407 , discussion 417–418
    CrossrefPubMedGoogle Scholar
  • 14 Levin LS. Invited discussion: face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery 2009; 29 (7) 524
    CrossrefPubMedGoogle Scholar