Effects of flap design on distal tissue perfusion in perforator flaps

Abstract Background and objectives: Perforator flaps, both pedicled and free flaps, are increasingly used in reconstructive surgery. However, the microvascular perfusion pattern within these flaps still remains essentially unknown. It is well known that in random-pattern flaps, flap length correlates directly with the width of the flap base. In perforator flaps, the importance of preserving a skin base is still an object of debate. We hypothesized that by dividing the skin base peripheral tissue perfusion in islanded perforator flaps increases. The abdominal panniculus in patients submitted to elective abdominoplasty was used to test and compare perforator flaps (intact skin bridge at the flap base in addition to a single perforator) and islanded perforator flaps (a single perforator located at the base of the flap only). Methods: Flap perfusion was measured using dynamic laser induced fluorescence videoangiography (IC-VIEW, PULSION medical systems AG, Munich, Germany). The abdominoplasty flap was used to create the intended flaps and the fluorescent dye indocyanine green (ICG) was injected intravenously. Special software (IC-CALC) was used for quantitative analysis. The fluorescence intensity was compared after 2 minutes of registration. The results are presented as mean ± SEM, and considered statistical significant when P < 0.05. Results: An increase in mean pixel intensity represents an increase in tissue perfusion. After surgical release of the skin base in the perforator flaps, the ICG fluorescence increased in zone I (the most distal zone) in the islanded perforator flaps (n=24, P