Intra and postoperative evaluations of microcirculation and micro-rheological parameters in a rat model of musculocutaneous flap ischemia-reperfusion

Abstract

PURPOSE:To examine how the ischemia-reperfusion injury of latissimus dorsi-cutaneous maximus (LDCM) musculocutaneous flap affects the microcirculatory (flap's skin surface) and hemorheological parameters, and whether an intraoperative deterioration would predictively suggest flap failure in the postoperative period. METHODS:Ten healthy male rats were subjected to the study. In Group I the left flap was sutured back after 2-hour, while the contralateral side was right after its elevation. In Group II the same technique was applied, but the pedicle of the left flap was atraumatically clamped for 2-hour. The contralateral side was left intact. On the flap skin surface laser Doppler tissue flowmetry measurements were done before and after and during the protocols applied in the groups. Microcirculatory and hemorheological examinations were done postoperatively. RESULTS:The microcirculatory parameters significantly decreased during immobilization and ischemia. Afterwards, all the regions showed normalization. In the retrospective analysis there was a prominent difference between the microcirculatory parameters of necrotic and survived flap during the early postoperative days (1-3) in Group II. Erythrocyte aggregation and deformability showed only slight differences.CONCLUSIONS: Two-hour ischemia and reperfusion caused deterioration in latissimus dorsi-cutaneous maximus flap microcirculation.Predicting the possible postoperative complication, the intraoperative laser Doppler measurement can be informative.

Impact of groin flap ischemia-reperfusion on red blood cell micro-rheological parameters in a follow-up study on rats

“…Klarik et al examined the hemorheological (red blood cell deformability and aggregation) and microcirculatory parameters (laser Doppler fluxmetry) after two-hour ischemia in latissimus dorsicutaneus maximus musculocutaneous flap in a rat model [15]. They found that besides the non-specific, acute phase-driven micro-rheological alterations, the I/R caused deterioration in flap microcirculation.…”

“…Microcirculatory follow-up was important in prediction the possible postoperative complications, such as flap thrombosis and consequent flap failure [15].…”

“…Numerous investigations were done in different types of experimental animals to improve surgical safety [7,15,26,27,32]. At our Department some studies were completed earlier in this field: using latissimus dorsi muscle flaps on beagle dogs [26], and latissimus dorsi -cutaneous maximus musculocutaneous flaps on rats [15].…”

Effect of short-term ischemia on microcirculation and wound healing of adipocutaneous flaps in the rat

“…In this aspect the intra-or early postoperative monitoring has a great importance 1,3,20 . In previous animal models the method was found to be useful to reflect or even predict postoperative complications 4 .…”

“…Viability of various composite flaps is a key factor of the successful reconstructive operation. Numerous clinical and experimental studies demonstrated that microcirculatory disturbance may lead to flap failure [1][2][3][4] . Mechanical damage during flap preparation and positioning, bending and torquation of pedicle's vessels, thrombosis, edema, inflammation, all may lead to complication, resulting in flap necrosis 5,6 .…”