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The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model

  • Olariu, Radu1
  • Moser, Helen Laura1
  • Lese, Ioana1
  • Sabau, Dan2
  • Georgescu, Alexandru Valentin3
  • Grobbelaar, Adriaan Ockert1
  • Constantinescu, Mihai Adrian1
  • 1 Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Bern, Switzerland
  • 2 Surgical Clinic 2, Emergency County Hospital, Victor Papilian Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania
  • 3 Department of Plastic Surgery, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published Article
Archives of Plastic Surgery
Korean Society of Plastic and Reconstructive Surgeons
Publication Date
May 15, 2020
DOI: 10.5999/aps.2019.00871
PMID: 32453928
PMCID: PMC7264910
PubMed Central


Background Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival. Methods In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap). Results Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1. Conclusions Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model.

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