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  • Title: [Vascular territory expansion: a surgical technique for augmenting survival of an animal model of a musculocutaneous flap].
    Author: Dorion D, Boyd JB.
    Journal: J Otolaryngol; 1991 Oct; 20(5):320-4. PubMed ID: 1835736.
    Abstract:
    Ischemia-induced flap failure remains a major concern for reconstructive surgeons. A porcine rectus abdominis musculocutaneous (TRAM) flap was designed and subsequently used to study our hypothesis of vascular territory expansion whereas the perfusion territory of a previously ligated vessel is taken over by the remaining vessel(s). Specifically, we observed that ligation of the superior epigastric (SE) vessels two weeks prior to raising the TRAM flap significantly (p less than 0.05) increased the length and area of the viable skin in the transverse skin paddles of the treatment flaps compared to the contralateral sham manipulated control flaps. This significant increase in skin viability was seen to be accompanied by a significant (p less than 0.05) increase in skin and muscle capillary blood flow in the treated flaps compared with the controls (n = 9). The mechanism of vascular territory expansion is unclear. We postulate that hypoxia resulting from the ligation of the SE vessels prior to the flap surgery may play a role in triggering the deep inferior epigastric (DIE) artery to take over some of the territory previously perfused by the SE artery.
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