Experimental study on the prefabricated tram flap of rabbits with enhanced neovascularization

Kim, Yeong Jo; Han, Seung Kyu; Lee, Byung IL; Kim, Woo Kyung; Han, Jae Sik

Abstract

There are occasions when standard techniques of reconstructive surgery for traumatic injury, tumor resection, and correction of congenital anomalies cannot be used as a result of the unavailability of tissues, absence of healthy vascular pedicle or excessive morbidity in donor area. It is established that autogenous skin, muscle, bone, and other composite tissue can retain their viability in varying degree as a prefabricated `flap with vascular pedicle implantation and the survival rate of these flaps has increased with tissue expansion or PGE1 infusion. The purpose of this study was to demonstrate the reliability of the secondary or prefabricated rectus abdominis musculocutaneous flap, and to evaluate the effect of the several factors on the survival routes of these flaps. Fifty New Zealand white rabbits weighing from 250 to 350 gm were used for the study. On the abdominal area bipedicled skin flaps are elevated as a random pattern flaps and were prefabricated using with rectus muscle. The fifty flaps were studied. They were divided into the five groups as follows; group I, 10 x4 cm classic axial pattern transverse rectus abdominis muscle (TRAM ) flaps were made as a control group (n = 10); groupII, 10 x4 cm random pattern bipedicled skin flaps were prefabricated using right rectus muscle with the delay procedure(n = 10); group III, 5 x4 cm prefabricated musculocutaneous flap were made same as group II on the right, side, tissue expansion was performed on the left side (n = 10); group IV, same procedure was performed as group II, and in addition postoperative intravenous infusion of PGE1 was given(n = 10); group V, same procedure was performed as group III, and in addition postoperative intravenous infusion of PGE1 and tissue expansion was performed(n = 10). Flap survival rates of each group were evaluated and compared. The following results were obtained: 1. Survival rates of prefabricated flaps were lower than that of classic axial pattern flaps regardless of using tissue expansion and PGE1 infusion(p < 0.05). 2. In making a comparison between flap with and without PGE1 infusion, survival rates of prefabricated flaps infused with PGE1 were higher than that of flaps without PGE1 infusion. 3. The prefabricated flaps managed with tissue expansion had higher survival rates than that of flaps without using tissue expansion. 4. The survival rates of prefabricated flaps managed in combination with tissue expansion and PGE1 infusion were significantly higher than that of other groups except control group. In conclusion, this study demonstrated the significance of combiring use of tissue expansion and PGE1 infusion in a prefabricated musculocutaneous flaps as a reliable method.