Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps

Article informationBackground: The coverage of the distal third of the leg and foot was still a challenge for reconstructive surgery due to its limited distensibility and mobility, low blood supply, and lack of muscle tissue interposition between noble structures and the integument. These features make randomized grafts and flaps unsuitable for wounds in this region. Aim of the work:To assess the potentiality of [two stages] versus [one stage] distally based reverse sural flap for distal third of leg and foot reconstruction. Patients and Methods:This meta-analysis included the recent updates as we retrieved 77 references to studies. After examination of the titles and abstracts of these references, we eliminated all of those which did not match our inclusion criteria and those which were clearly ineligible from the review. We obtained full text copies of the remaining seven potentially eligible trials for further evaluation.Results: Seven studies assessing rate of Partial necrosis among two groups showing that there were insignificant differences. seven studies assessing rate of complete flap necrosis among two groups showing that there were insignificant differences. seven studies assessing rate of secondary procedures among two groups showing that there were insignificant differences. three studies assessing rate of hospital-stay\days among two groups showing significant longer stay among single staged group. Conclusion:The distally based reverse sural flap is a versatile flap for the reconstruction of soft tissue defects of the lower leg and heel.

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“…Supercharged sural flap is one such modification. However, this procedure requires microsurgical expertise and is technically demanding [18] .…”

Section: Discussionmentioning

confidence: 99%

One Stage versus Two Stages Distally Based Reverse Sural Flap for Leg and Foot Reconstruction: A Meta-Analysis Study

Younis

Hassan

Helmy

2023

International Journal of Medical Arts

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“…An additional vein in the distal part of the flap could promote venous drainage and improve flap complications. 27,28 Another view is that an additional artery in the distal part of the flap could increase arterial blood supply, thus improving flap complications. 29–32 However, arterial supercharging also affects the vein, increasing the burden of venous drainage, which could lead to flap necrosis if used improperly.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap

Cheng

Lou

et al. 2019

Plastic &Amp; Reconstructive Surgery

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Background:Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap.Methods:Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed.Results:The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05).Conclusion:Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.

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Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats

et al. 2020

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Background Arterial supercharging and venous superdrainage have been the commonly used vascular augmentation techniques for resolving partial loss of flaps in reconstructive surgery. It remains controversial which one of them is more effective in improving flap survival. The purpose of this study was to compare the effect of distal venous superdrainage and arterial supercharging on the survival of an extended dorsal perforator flap in rats. Materials and Methods Sixty Sprague–Dawley rats were randomly divided into three groups (n = 20 in each group). An extended dorsal perforator flap with the size of 3 × 12 cm based on the deep circumflex iliac artery and vein was elevated in each rat. In arterial supercharging group, the thoracodorsal artery was retained as the distal supercharging vessel; In venous superdrainage group, the thoracodorsal vein was retained as the distal superdrainage vessel. In control group, no other arteries and veins were retained except the main vascular pedicle. On the seventh day after operation, the survival area of flap was calculated as a percentage of viable area to the total flap. Vascular changes in the choke zones were assessed by angiography. Microvascular density and diameter were assessed via immunohistochemistry staining of CD31 on the fifth day after operation. Results The flap survival area in arterial supercharging group was significantly higher than that in venous superdrainage group (98.9 ± 0.8% vs. 81.5 ± 3.5%, p < .001). By gross observation, the extent of dilation of choke zone vessels in venous superdrainage group was smaller compared with that in arterial supercharging group. The density of CD31‐positive vessels and the diameter of choke zone vessels in arterial supercharging group were significantly larger than that in venous superdrainage group (23.4 ± 4.6 mm−2 vs. 13.1 ± 4.2 mm−2, p < .05; and 37.5 ± 5.8 μm vs. 27.8 ± 4.9 μm, p < .05). Conclusion Compared with venous superdrainage, distal arterial supercharging in the potential territory resulted in better survival of an extended dorsal perforator flap in a rat model.

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Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps

Cited by 22 publications

References 37 publications

One Stage versus Two Stages Distally Based Reverse Sural Flap for Leg and Foot Reconstruction: A Meta-Analysis Study

One Stage versus Two Stages Distally Based Reverse Sural Flap for Leg and Foot Reconstruction: A Meta-Analysis Study

A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap

Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats

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