The effect of intraoperative changes in the blood flow in the feeder artery of the fasciocutaneous flap on its engraftment quality (an experimental study)

Purpose. To reveal the correlation of blood flow in the artery supplying a fasciocutaneous flap with its engraftment quality. Materials and Methods. A flap of 18 cm² area was formed in 16 rats on the basis of the superficial inferior epigastric artery (SIEA) and replanted after 90-minute period of femoral artery clipping at the point of SIEA embranchment. The volume blood flow was registered immediately after the flap elevation, at the moment of the clip removal from the artery and for 10 minutes after the removal using T101 ultrasound flowmeter. 12 days later the animals were euthanized. True color digital images of the flap inner and outer surfaces were obtained by Sony Cyber-shot DSC-HX100V camera macro mode. Venous congestion severity of the flap and its subcutaneous fat necrosis were revealed using the semi-quantitative method of expert evaluations. The proportion of epidermis defects (in percentage of the flap area) was determined in the digital images of the flap external surface using the method of point-counting computer-assisted planimetry, and the proportion of vascular structures and extravasations was determined by analyzing the images of the inner surface. Results. Three variants of reperfusion were documented intraoperatively when analyzing the character and amount of the change in volume blood flow: hypoperfusion, moderate hyperperfusion, and severe transient hyperperfusion. In case of the second variant epidermis defects, the mean values of venous congestion severity and subcutaneous fat necrosis, as well as the proportions of extravasations were the lowest, while the percentage of vascular structures was the highest. The extent of venous congestion and the proportion of extravasations were reliably higher in the first variant in comparison with the second one. The severity of subcutaneous fat necrosis and the percentage of extravasations were higher in the third variant than in the second one. The most favorable rates of engraftment were observed for the second variant. Conclusion. The intraoperative study of volume blood flow in the artery supplying the flap allows to evaluate the risk of reperfusion injury of its vascular bed, venous congestion, and subcutaneous fat necrosis.

васкуляризованный кожно-фасциальный лоскут, кровоток, флоуметрия, vascularized fasciocutaneous flap, blood flow, flow me try

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