The Effective Duration of the Delay Period on the Survival and Vascularization of the Prefabricated Cutaneous Flap

Lee, Byung Il

Abstract

This study was designed to investigate the effective duration of delay period, and to study what changes were induced in the vasculatures of the prefabricated cutaneous flap. Abdominal skin flaps in six groups were fabricated by the subcutaneous implantation of a skeletonized saphenous pedicle using fourty-eight male Sprague-Dawley rats. Forty flaps were elevated at six weeks after fabrication, based solely on the implanted pedicle. Group 1 was used as the control without delay. A surgical delay was carried out at 24, 48, 72 hours, and 7 days prior to flap elevation in the group 2, 3, 4, and 5, respectively. Eight flaps of the group 6 were elevated without delay at 8 weeks after fabrication. Three days later, the flap viability and the numbers of vessels were analyzed quantitatively, and the flap vasculature was evaluated with microangiograms. Flap viabilities of the group 3(95.3+/-7.04) and 4(98.5+/-2.90) were higher than that of the control(83.4+/-11.17, p<0.05). In microangiographic study, the connection between dilated large vessels via choke vessels is dominant finding during the first 24 hours after delay. Dilatations of preexisting small choke vessels started to be appear at 48 hour after delay, and vascular networks of small vessels were progressively developed over the whole flap at 72 hours after delay. The number of vessel, in the flap itself, was increased after 72 hours of delay(p<0.05), but new vessels around the pedicles were more developed at 48 hours after delay(p<0.05). In conclusion, the delay procedure enhances the viability of the prefabricated flap, and the optimal duration is 48 - 72 hours to obtain maximal survival in rats.