High-pressure infusion improves multi-territory perforator flap viability via choke artery dilation: A preliminary study in a rat model

Sheng Cheng; Anyuan Wang; Hongfeng Ding; Jian Ding; Long Wang; Weiyang Gao

doi:10.1016/j.bjps.2023.06.002

High-pressure infusion improves multi-territory perforator flap viability via choke artery dilation: A preliminary study in a rat model

J Plast Reconstr Aesthet Surg. 2023 Sep:84:505-513. doi: 10.1016/j.bjps.2023.06.002. Epub 2023 Jun 9.

Authors

Sheng Cheng¹, Anyuan Wang², Hongfeng Ding¹, Jian Ding², Long Wang², Weiyang Gao³

Affiliations

¹ Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China; Department of Second Clinical Medical, the Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
² Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China.
³ Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China. Electronic address: weiyanggaoi@126.com.

PMID: 37418849
DOI: 10.1016/j.bjps.2023.06.002

Abstract

Background: Multi-territory perforator flaps have become the preferred option for the repair and reconstruction of large soft tissue defects. Although methods (e.g., pharmacological agents, mechanical stimulation, and thermal stimulation) were developed to open choke vessels to improve flap survival, the flap necrosis rate is still as high as 28.8%. The authors hypothesized that high-pressure infusion might enhance flap viability by dilating choke arteries intraoperatively in a rat model of multi-territory perforator flap.

Methods: Two-month-old male Sprague-Dawley rats were randomized into two groups (n = 32 each). During the multi-territory perforator flap elevation based on the right superficial epigastric angiosome, one group received continuous high-pressure infusion (mean pressure, 250 mmHg; duration, 1 min) of an isotonic heparin sodium solution (12,500 U/L) via the artery in the pedicle, whereas the other group received no infusion. At 7 days postoperatively, arteriography was performed; endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) expression and microvascular density were evaluated by western blot and histology, respectively; and flap survival was compared. Moreover, intraluminal diameters were examined at 1 day and 7 days postoperatively using hematoxylin and eosin staining, and coagulation function was assessed immediately postoperatively.

Results: High-pressure infusion significantly promoted the dilation of choke arteries at 1 day and 7 days postoperatively. It also increased eNOS and VEGF expression, flap survival, and microvascular density. The coagulation function remained unaffected.

Conclusions: High-pressure infusion allowed intraoperative and postoperative dilation of the choke arteries that enhanced the viability of multi-territory perforator flaps in rats.

Keywords: Choke vessels; High-pressure infusion; Multi-territory perforator flap; Rats; Reconstructive surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Arteries
Dilatation
Graft Survival
Male
Perforator Flap* / blood supply
Rats
Rats, Sprague-Dawley
Vascular Endothelial Growth Factor A / metabolism

Substances

Vascular Endothelial Growth Factor A