Influence of Recipient-Bed Isolation on Survival Rates of Skin-Flap Transfer in Rats

The effect of recipient-bed isolation with artificial barriers on skin-flap survival, compared to flap transfer without bed isolation, was evaluated in a modified rat epigastric skin-flap model. The pattern of blood flow in the raised flap with a proximal axial portion and distal random portion was confirmed by laser Doppler flowmetry. Forty rats were divided into four groups. Three of the groups had one of three different artificial barriers-silicone, polypropylene, or gelatin sponge. In each of these three groups, one of the artificial barriers was placed between the flap and its recipient bed after flap replacement. The flaps without bed isolation (Group 4) were used as controls. The survival area was measured 7 days postoperatively. Results demonstrated that necrosis in the groups with silicone and polypropylene barriers was significantly higher than in the controls. Histologically, neovascularization was shown in the flaps without artificial barriers. Foreign-body reactions were observed in the flaps with bed isolation and among these, severe inflammation and congestion were seen in the flaps with polypropylene isolation. In this study, the authors demonstrated that the random portion of a rat skin flap could survive partially through imbibition of plasma and the ingrowth of new vessels from the recipient bed. This neovascularization can be prevented by recipient-bed isolation with an artificial barrier. Bed isolation with a silicone sheet is suggested for use in the study of rat skin-flap survival.