Experimental Research In Rabbits And Clinical Application Of Intermuscular Septum Perforator Pedicled Flap And Perforator-plus Fasciocutaneous Flap

Objective:The purpose of the present study is to explore and set up the more ideal model of intermuscular septum perforator pedicled flap and perforator-plus fascicutaneous flap in rabbit, to explore the role of the fasciocutanoeus pedicle in arterial blood supply and veneous drainage of the perforator-plus fascicutaneous flap by comparing the survial rate of two kinds of flaps, and summarize the clinical experience of the posterior tibial artery perforator pedicled flap and perforator-plus fasciocutaneous flap.Methods:In the experiment of creating the flap models,17New Zealand rabbits were performed gross anatomy of the leg, radiograph and microanatomy of legs which were injected with barium sulfate-latex, and sapehenous artery perforator pedicled flap and perforator-plus fascicutaneous flap. Sixteen legs of8rabbits were randomly divided into2groups:one group was used to harvest sapehenous artery perforator-plus fascicutaneous flaps (the pedicle length of2.0cm and width of1.5cm, the skin island demension of6.0cm×3.0cm), and the other to harvest sapehenous artery perforator pedicled flaps (demensions of long axis part:2.0cm×1.5cm plus6.0cm×3.0cm), with the pivot point locating at3.0cm below the knee joint. According to the defferent pedicles,18legs of9New Zealand rabbits were randomly devided into3groups:group A(perforator pedicled flap), group B(fasciocutaneous pedicled flap without perforator at the base of the pedicle), and group C (fasciocutaneous pedicled flap with perforator artery but without perforator vein at the base of the pedicle). At7days postoperatively, all the flaps’survival rates were recorded. The flaps, just being elevated from the legs, were executed injection of methylene blue from the perforator artery of the sapheneous artery (2cases) and the perforator vein of the femoral vein (3cases). The sapehenous artery perforator pedicled flaps (n=2) and perforator-plus fascicutaneous flaps (n=2), which had survived completely10days postoperatively, were injected barium sulfate-latex from femoral artery, and the specimens were performed radiograph and microanatomy. Two sapehenous artery perforator-plus fascicutaneous flaps, which had survived completely10days postoperatively, were injected barium sulfate-latex from sapehnous vein, and the specimens were performed radiograph. The meglumini diatrizoici radiography were taken by means of manual control infusion of the contrast medium via perforator artery of the saphenous artery (n=2) and perforator vein of thefemoral vein (n=2). We retrospectively reviewed the data of the posterior tibial artery perforator pedicled flaps (n=19) and perforator-plus fasciocutaneous flaps (n=68) and summarized the clinical experiences of both flaps.Results:The saphenous vessel gives out3to5intermuscular perforators from the knee joint to the ankle joint, and the location of perforator at3.0cm below the knee joint is relatively constant and sizable, and its ocurrence rate is100%and its external diameter is (0.36±0.06)mm. Pivoting on this perforator, survival rates of sapehenous artery perforator pedicled flap and perforator-plus fascicutaneous flap were90.8%and77.0%, respectively, in the experiment of creating the flap models. In the formal experiment, survival rates of sapehenous artery perforator pedicled flap and perforator-plus fascicutaneous flap were90.4%±22.5%and94.0%±9.9%, respectively (P>0.05). Survival rates of group A, B and C were83.8%±23.7%,45.7%±25.3%and55.0%±47.2%, respectively (P>0.05). Injection of methylene blue through perforator artery from saphenous artery showed that the blood in flap was mainly drained by the perforaor vein from the saphenous vein at the base of the flap, some blood was drained via anastomosis between perforator veins in the fasciocutaneous pedicle. Injected survival flaps with barium sulfate-latex showed, branches of perforator artery and vein as the vessel pedicle distributed the whole flap, the perforator artery and vein below the base of the fasciocutaneous pedicle anastomosed with the vessels in part of the flap near the pedicle; there were abundant anastomoses between perforator vein at the base of the pedicle and perforator vein below the former, and these anastomoses linked with both many little superficial veins and perforator vein of the anterior tibial vein distal to and around the fasciocutaneous pedicle. The meglumini diatrizoici radiography showed that the blood in veins was mainly drained by the perforaor veins at the base of the pedicle, and no contrast medium was seen on the fasciocutaneous pedicle. At the time of review, follow-up of all the patients was carried out, there was no complete necrosis flap in this series. Necrosis rates of the posterior tibial artery perforator pedicled flaps and perforator-plus fasciocutaneous flaps were21.1%and19.1%(P>0.05).Conclusions:(1) Based on the perforator from the saphenous vessel at3.0cm below the knee joint, the sapehenous artery perforator pedicled flap and perforator-plus fascicutaneous flap in rabbit is an ideal experimental model which can serve as the flap models for additional studies in this field.(2) With respect to sapehenous artery perforator-plus fascicutaneous flap, the perforator is the main approach for arterial supply and venous drainage of the flap, and the fasciocutaneous pedicle can play a part role in both terms above. The venous blood can be drained via not only the homologous perforator vein distal to the base of the flap but also the superficial vein and perforator vein from other main vessel which anamoses with the peforator veins from the saphenous vessel.(3) There is no difference between the posterior tibial artery perforator pedicled flap and perforator-plus fasciocutaneous flap in reliability.