The purpose of this study is to explore a silk ligation delay
for the expanded and unexpanded random flaps to improve the vascularization and survival length of the flap.
Marked incision points 2 to 3 cm at every interval along the design line with methylene blue, each incision was about 3 mm long. A subepidermal tunnel was formed on the superfacial layer of dermis between every adjacent incision; another gap was done on the surface of the expander. One end of a No 7 silk thread was inserted into the incision and traversed the surface of the expander until the adjacent incision point, then returned back to the original site through subepidermal tunnel. The both ends of the thread were ligated together to a single knot. All the designed points were performed as above. Then, the ligation procedure was performed along the long axis of the flap from proximal to distal. Both ends of each silk thread were tightly ligated together to a square knot to clamp the soft tissues including the vessels entering the flap. The progress of ligation should depend on blood supply changes of the flap. Remainders would finish under local anesthesia with 0.5% lidocaine or surface anesthetic cream in dressing room at 5 to 7 days after operation as schedule. After that the authors tested the blood supply of the flap and decided the opportunity of final transfer.
There were no complications such as infection, wound dehiscence, expander exposure, significant effusion, and necrosis of the flap in all patients. All the flaps survived completely. Only 1 expander rupture happened during delay operation.
The technique is a safe and reliable method, it is simple and easy for application, it may provide another choice for the surgical delay