Effect of the delay phenomenon in the rat single-perforator-based abdominal skin flap model

During the last decade, innovations in reconstructive surgery have presente d a new type of flap called the "perforator-based flap," Perforator-based f laps became useful alternatives for solving difficult problems. In the auth ors' previous study, they created a single musculocutaneous perforator-base d abdominal skin flap. In their current study they evaluate the effect of v arious surgical delay procedures on this model. They divided 32 Sprague-Daw ley rats equally into four groups (one control group and three delay groups ). Three different delay procedures were employed in the delay groups. In o ne group, only the flap boundaries were incised (delay group 1), In the oth er delay groups, flap boundaries were incised and the contralateral (opposi te side of the pedicle, delay group 2) or ipsilateral (pedicle side, pedicl e left intact; delay group 3) musculocutaneous perforators were ligated. Th e period of delay was 1 week in all groups. After 1 week, a single-perforat or-based abdominal skin flap was elevated as in the control group. One week after the final procedure, surviving skin areas were calculated and microa ngiograms were acquired. The mean surviving skin area was 75% +/- 3% (stand ard deviation) in the control group, 97% +/- 3% in delay group 1, 81% +/- 6 % in delay group 2, and 96% +/- 3% in delay group 3, Delay group 2 showed s ubstantial necrosis 1 week after the delay procedure and was thus excluded from the study. Results were analyzed using one-way analysis of variance, a nd post hoc analyses were performed using Tukey's multiple comparison test. The authors observed the advantages of the delay phenomenon in the two del ay groups (p < 0.05). Microangiograms were examined grossly, and a marked d ifference between the two delay groups and the control group was observed. Many dilated choke vessels were seen in delay groups 1 and 3, Incising the flap boundaries with or without ligating the ipsilateral perforators (keepi ng the pedicle intact) 1 week before harvesting single-periorator-based abd ominal skin naps in the rat results in a delay effect. Conversely, incising the flap boundaries and ligating the contralateral perforators have no del ay effect in this model.