Prefabricated venous flap, an advanced free venous flap for distant transfer: An experimental rat study

Abstract

Abstract Background Arterialized venous flap can improve the survival of traditional free venous flap. Arterialized venous flaps are, however, still not popularly selected as the first choice for microsurgical reconstruction because of its nutrient insufficiency. Materials and Methods Eighty-four Lewis rats (10–12 weeks old, 350–400 g) were used. Left hemivertical chest-and-abdominal skin flap (4 × 14 cm2) was the experimental model. Five protocols were designed and performed: protocol I (n = 18), nutrition territory study; protocol II (n = 18), immediate A-V anastomosis; protocol III (n = 12), prefabricated venous flap (PFVF) transformed from pedicle-based skin flap; protocol IV (n = 18), PFVF transformed from perforator-based skin flap; and protocol V (n = 18), PFVF transformed from capillary-based skin flap. The all transformed PFVFs had a 2-week delay procedure from the original skin flaps. Results The hemivertical chest-abdomen skin flap contains 3 nutrient vessels: superior, inferior, and midabdominal. The PFVF coming from the perforator-based skin flap showed significantly superior than other 2 methods with the best survival rates after arterialization, followed by the capillary-based skin flap and then the pedicle-based skin flap. Conclusions The PFVFs after delay procedure and arterialization have been proved to greatly increase the flap survival than traditional free venous flap. Delay procedure has benefits for the transformation from the nutritional skin flaps into PFVFs, which is especially true in perforator-based skin flaps. Such transformation is a 2-stage procedure. Prefabricated venous flaps might offer a “last case scenario” surgery as an option to reconstruct wound defects where no other suitable skin flaps are available. Further investigation is warranted.