Experimental Studies And Clinical Application Of The Dilated Perforator Flap

Objective Based on the previous abdominal perforator vascular anatomy anddynamics researches and to establish a new operative pig model of abdominalperforator flap. Research soft tissue dilatation can influence perforator flap survivalarea and the survival rate, and investigate the method and effectiveness of expandeddelto-pectoral and abdominal perforator flaps in repairing large scars of the face andupper limb after scar excision.Methods1Hemodynamics in the superior epigastric arteries(SEAs) of2maturepigs(maleZ，femaleZ) were evaluated by Color Dopplex Ultrasonography(CDU).Vascellum constructions of SEAs were gained by the method of glutin injection.Abdominal anatomies were done and documented, to evaluate the both sides of theSEAs Vascellum constructions differences, and research anatomic relationships of SEAsand their perforators, including the origin, course, bifurcations, disturibution.24pigs were used as experimental animals, which were allocated into expansionand unexpansion groups. The soft tissue expander(100ml in volume)were implanted inthe abdominal region, performed up to2cm outside of perforator point under the deepfascia layers at marked regions (avoiding damage to the perforator vessels).Ten daysafter surgery, we began to gradually inject water into the expander2-3times eachweek10to20percent each time. In total, injection was carried out for one month.Surgery for pedicle division was carried out after one month, the flap areas rangedfrom3cm×15cm. SPECT was made to detect the flap and predict survival area of skinflap after one week. Visual assess all flaps every day and seven days after the operation, the flap survival rate was recorded.3Therewere14malesand11femaleswithanaverageageof27years(range7-36years). About300ml to500ml volume soft tissue expanders were implanted in thedelto-pectoral zone and abdominal region in primary operation. In two-stage operation,after scars were resected, defects (9cm×7cm～17cm×18cm)were repaired with thedelto-pectoral perforator flaps(17cm×7cm～20cm×8cm) in15facial scar cases andthe deep inferior epigastric artery perforator flaps(10cm×9cm to25cm×14cm) in10upper limb and hand scar cases. The donor sites were sutured directly.Results1Vascular series had good symmetries in both Sides of the superiorepigastric arteries.The perforator vessel of abdominal skin arose from the superiorepigastric system. There are five or six perforators coming from the both sides of thesuperior epigastric arteries. Deep inferior epigastric artery has been unconspicuousperforator artery.2All flaps of these cases were not infection and crack. The flap survival rate was(84.08±7.41)%in Group A,(72.89±8.45)%in Group B,(68.83±2.57)%in Group C,and (41.42±3.25)%in Group D. There was statistical significant between Group A andB, A and C, C and D. SPECT can predict the flap’s survival area.3Partial necrosis of the flaps occurred in2cases after operation, then the flapsurvived after expectant treatment. The other flaps and skin grafts survivedsuccessfully, and the incisions healed by first intention.10patients were followed up6months to4years. The appearance, texture, and color of the flaps were similar to thoseof the donor site.Conclusion1There are five or six perforators coming from the both sides of the superiorepigastric arteries. The both superior epigastric arteries had good symmetries. 2Softtissuedilatationcanincreaseperforatorflapsurvivalareaandthesurvivalrate.3It is an effective method to use the delto-pectoral perforator flap and the deepinferior epigastric artery perforator flap for repairing soft tissue scars of the face andupper limb.