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Selective Percutaneous Desiccation of the Perforators with Radiofrequency for Strategic Transfer of Angiosomes in a Sequential Four-Territory Cutaneous Island Flap Model

Demirtas, Yener M.D.; Ayhan, Suhan M.D.; Findikcioglu, Kemal M.D.; Yavuzer, Reha M.D.; Atabay, Kenan M.D.

Plastic and Reconstructive Surgery: May 2007 - Volume 119 - Issue 6 - p 1695-1706
doi: 10.1097/01.prs.0000258839.78758.35
Experimental: Original Articles

Background: Research in prevention of partial flap necrosis has recently concentrated on extending the safe length of a flap by ligating vessels of known territories. To advance this approach one step further, the authors decided to reveal the least invasive surgical strategy for transfer of angiosomes.

Methods: The study was arranged into three experiments. In the first experiment (n = 17 rabbits), a cutaneous island flap model spanning four adjacent vascular territories was developed. In the second experiment (n = 15 rabbits), the flap model was used to test the possibility of desiccating those vessels supplying the angiosomes to be captured percutaneously with radiofrequency. The delay procedures were performed by means of minimal skin incisions, and the flaps were elevated after a 2-week delay period. In the third experiment, the effectiveness of selective interference of these pedicles was compared to minimize the number of target vessels for successful transfer of angiosomes.

Results: The mean surviving area of the new flap model was 63 ± 2 percent. The mean surviving flap area was 97 ± 3 percent for the endoscopy equivalent technique and 94 ± 4 percent for radiofrequency delay. The results were statistically insignificant between these two groups. In experiment 3, comparison of the results yielded a statistically insignificant difference for flap survival area among all four of the groups.

Conclusions: An alternative flap model is introduced for future investigation of the vascular delay process. Percutaneous desiccation of the perforators with radiofrequency was found to be a reliable method, and selective desiccation of the perforator(s) was as efficient as destruction of all vascular sources other than the pedicle.

Ankara, Turkey

From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Gazi University, Faculty of Medicine.

Received for publication June 28, 2005; accepted October 27, 2005.

Submitted to the Plastic Surgery Educational Foundation 2005 Scientific Essay Contest, and winner of the Annual Bernard G. Sarnat, M.D., Basic Science–Junior Award.

Yener Demirtas, M.D., Ondokuz Mayis Universitesi Tip, Fak. Plast. Rek. Est. Cer. AD., 55139, Kurupelit, Samsun, Turkey,

©2007American Society of Plastic Surgeons