Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon

Abstract

The torsion of the flap's pedicle is one of the most common conditions causing vascular compromise. We aimed to compare the resistance to torsion of axial flap pedicle and perforator pedicle patterns. In the second part of the study, we investigated whether the delay phenomenon is an effective method for improving perforator flap resistance to pedicle torsion. In the first phase, 90 male Wistar rats were randomly divided into two groups: perforator and axial. Bilateral groin flaps were elevated in the axial group and bilateral posterior thigh perforator-based flaps were elevated in the perforator group. Viable flap areas were compared at 90, 180, 270, 360, and 720 degrees of pedicle rotation. Microangiographic and histopathological studies were performed. As a result, necrosis was seen following earlier rotation in the perforator group and viable flap areas were also lower. In the second phase, after delay procedure, the perforator flaps were exposed to 270, 360, and 720 degrees of pedicle rotation. With the delay procedure, no significant difference in viable flap areas was observed. In conclusion, the resistance to torsion of the axial flap pedicle pattern was greater than that of the perforator pedicle pattern, and the delay procedure was not an effective method for improving flap resistance to torsion.