Pedicle streaking: A novel and simple aid in pedicle positioning in free tissue transfer

Abstract

Introduction:The pedicle positioning in free tissue transfer is critical to its success. Long thin pedicles are especially prone to this complication where even a slight twist in the perforator can result in flap loss. Pedicles passing through the long tunnels are similarly at risk. Streaking the pedicle with methylene blue is a simple and safe method which increases the safety of free tissue transfer.Materials and Methods:Once the flap is islanded on the pedicle and the vascularity of the flap is confirmed, the pedicle is streaked with methylene blue dye at a distance of 6-7 mm. The streaking starts from the origin of the vessels and continued distally on to the under surface of flap to mark the complete course of the pedicle in alignment. The presence of streaking in some parts and not in rest indicates twist in the pedicle.Observation and Results:Four hundred and sixty five free flaps have been done at our centre in the last 5 years. The overall success rate of free flaps is 95.3% (22 free flap failures). There has not been a single case of pedicle twist leading to flap congestion and failure.Conclusion:This simple and novel method is very reliable for pedicle positioning avoiding any twist necessary for successful free tissue transfer.

A comparison study of deep muscle sparing transverse rectus abdominis musculocutaneous flap for breast reconstruction

“…Therefore, an operator not well versed with the use of the DIEP could also perform DMS‐TRAM. Moreover, it had been reported that the presence of two perforators in a flap prevented the perforator from twisting due to flap rotation, which was an advantage of the present method (Aggarwal et al, ; Wong et al, ).…”

Comparison of flap outcomes between single‐ and multiple‐perforator‐based free anterolateral thigh flap in head and neck reconstruction

“…In addition, the use of intraoperative indocyanine green angiography as an objective tool to help visualize the supplied territory, including a part of the surrounding vastus lateralis muscle, dissection of the perforator under magnification of a surgical loupe to avoid inadvertent injures, intermittent topical lidocaine irrigation to minimize vasospasm, painting the pedicle with methyl blue dye, or creating a pseudo‐perforator using a fine suture that connects the stump of the main pedicle to the flap, thus forming a “safe triangle” to prevent unnoticed twisting as well as adequate soft tissue tunneling for pedicle transfer and careful hemostasis to prevent external compression by soft tissue swelling and hematoma formation, are strongly recommended. (Aggarwal et al, ; Ardehali, Mehrara, Cordeiro, & Mosahebi, ; Celik et al, ; Chen & Tang, ; Eren et al, ; Hamamoto, Nagasao, Ensako, & Tanaka, )…”