Transmidline Abdominal Skin Flap Model in Pig: Refinements and Advancements

Xin Minqiang; Luan Jie; Mu Dali; Mu Lanhua

doi:10.1055/s-0031-1289162

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2012; 28(02): 111-118
DOI: 10.1055/s-0031-1289162

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transmidline Abdominal Skin Flap Model in Pig: Refinements and Advancements

Xin Minqiang

¹Center of Breast Plastic and Reconstructive Surgery, Hospital of Plastic Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

Luan Jie

¹Center of Breast Plastic and Reconstructive Surgery, Hospital of Plastic Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

Mu Dali

¹Center of Breast Plastic and Reconstructive Surgery, Hospital of Plastic Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

,

Mu Lanhua

¹Center of Breast Plastic and Reconstructive Surgery, Hospital of Plastic Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

› Institutsangaben

Abstract

Abdominal flaps have recently gained considerable popularity in breast reconstruction, and their importance and advantages have been widely accepted. Given the unreliability of the distal parts in these flaps and the advancement of microsurgery, many modifications and improvements have been made. To get a better understanding of these flaps, researchers have encouraged the search for a suitable flap model. The purpose of this study was to clarify the anatomical and physiological features of the transmidline abdominal flap model in pig. We included 16 white female Yorkshire pigs in this study. In six pigs, the vascular anatomy of the abdominal region was studied by multidetector row computed tomographic angiography and anatomic dissection. In the remaining 10 pigs, three kinds of transmidline abdominal flap models were established. The pigs were scanned on the abdominal flap to evaluate the perfusion zones after the true abdominal transmidline flap was created, and then they were sacrificed to determine the flap survival area 7 days after surgery. The results of the study were as follows. (1) The pig's deep inferior epigastric vessels were smaller than deep superior epigastric vessels both in length and diameters. (2) The deep superior epigastric artery always bifurcates into two groups; each group gives off five or six branches. (3) The superficial superior epigastric veins were present, while the superficial epigastric arteries were absent in all the animals included. (4) The linea alba abdominis was tough and lack of vascular structures. The average perfusion units were 197.0 ± 24.2, 103.2 ± 36.4, 138.8 ± 25.4, and 30.2 ± 11.8 from zone I to zone IV. All the flaps underwent partial necrosis. The flap survival area percentage was 85.9 ± 4.1%. The transmidline abdominal skin flap in pig is a reliable and true abdominal flap model for future physiological studies, especially the circulatory dynamics in transmidline abdominal flaps.

Keywords

abdominal flap - experimental animal - flap model in pig

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Referenzen

References
1 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69 (2) 216-225
2 Hartrampf CR. Transverse Abdominal Island Flap Technique for Breast Reconstruction after Mastectomy. Baltimore: University Park Press; 1984: 84-88
3 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (1) 32-38
4 Restifo RJ, Ward BA, Scoutt LM, Brown JM, Taylor KJ. Timing, magnitude, and utility of surgical delay in the TRAM flap: II. Clinical studies. Plast Reconstr Surg 1997; 99 (5) 1217-1223
5 Harashina T, Sone K, Inoue T, Fukuzumi S, Enomoto K. Augmentation of circulation of pedicled transverse rectus abdominis musculocutaneous flaps by microvascular surgery. Br J Plast Surg 1987; 40 (4) 367-370
6 Barnett GR, Carlisle IR, Gianoutsos MP , BarBarnett GR The cephalic vein: an aid in free TRAM flap breast reconstruction. Report of 12 cases. Plast Reconstr Surg 1996; 97 (1) 71 76 discussion 77–78
7 Hallock GG, Rice DC. Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model. Plast Reconstr Surg 2005; 116 (2) 551-555 ; discussion 556
8 Chang H, Minn KW, Imanishi N, Minabe T, Nakajima H. Effect of venous superdrainage on a four-territory skin flap survival in rats. Plast Reconstr Surg 2007; 119 (7) 2046-2051
9 Yamamoto Y, Sakurai H, Nakazawa H, Nozaki M. Effect of vascular augmentation on the haemodynamics and survival area in a rat abdominal perforator flap model. J Plast Reconstr Aesthet Surg 2009; 62 (2) 244-249
10 Ueda K, Harashina T, Oba S, Nagasaka S. Which vessel is more important in the supercharged flap—artery, vein, or both? An experimental study. J Reconstr Microsurg 1994; 10 (3) 153-155
11 Hallock GG, Rice DC. Cranial epigastric perforator flap: a rat model of a true perforator flap. Ann Plast Surg 2003; 50 (4) 393-397
12 Daniel RK, Kerrigan CL. The omnipotential pig buttock flap. Plast Reconstr Surg 1982; 70 (1) 11-16
13 Haughey BH, Panje WR. A porcine model for multiple musculocutaneous flaps. Laryngoscope 1989; 99 (2) 204-212
14 Dorion D, Boyd JB, Pang CY. Augmentation of transmidline skin perfusion and viability in transverse rectus abdominis myocutaneous (TRAM) flaps in the pig. Plast Reconstr Surg 1991; 88 (4) 642-649
15 Offman SL, Geddes CR, Tang M, Morris SF. The vascular basis of perforator flaps based on the source arteries of the lateral lumbar region. Plast Reconstr Surg 2005; 115 (6) 1651-1659
16 Moon HK, Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 1988; 82 (5) 815-832
17 Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg 2004; 114 (5) 1077-1083 ; discussion 1084–1085
18 Reardon CM, O'Ceallaigh S, O'Sullivan ST. An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 2004; 57 (6) 515-519
19 Holm C, Mayr M, Höfter E, Ninkovic M. The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery. J Plast Reconstr Aesthet Surg 2007; 60 (8) 946-951
20 Blondeel PN, Arnstein M, Verstraete K , et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000; 106 (6) 1295-1299
21 Stell PM. The pig as an experimental model for skin flap behaviour: a reappraisal of previous studies. Br J Plast Surg 1977; 30 (1) 1-8
22 Mei J, Yin Z, Zhang J , et al. A mini pig model for visualization of perforator flap by using angiography and MIMICS. Surg Radiol Anat 2010; 32 (5) 477-484
23 Holm C, Mayr M, Höfter E, Ninkovic M. Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 2006; 117 (1) 37-43
24 Tran NV, Buchel EW, Convery PA. Microvascular complications of DIEP flaps. Plast Reconstr Surg 2007; 119 (5) 1397-1405 ; discussion 1406–1408
25 Shoaib T, Marucci D. Adjacent angiosomes instead of zones II and III: reply to “Perfusion zones of the DIEP flap revisited—a clinical study”. Plast Reconstr Surg 2006; 118 (3) 817-818 author reply 818
26 Vandevoort M, Vranckx JJ, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction. Plast Reconstr Surg 2002; 109 (6) 1912-1918