What’s the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supplyReport as inadecuate




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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.



Author: Yi Zhang , Tingliang Wang , Jiao Wei, Jinguang He, Tao Wang, Ying Liu, Hua Xu , Jiasheng Dong

Source: http://plos.srce.hr/



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