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Temporal Factors Affecting the Secondary Critical Ischemia of Normothermic Experimental Skin Flaps
Michel Babajanian, MD;
Wen X. Zhang, MD;
Jon B. Turk, MD;
Hubert Weinberg, MD;
Hugh F. Biller, MD;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 1991;117(12):1360-1364.
Abstract
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• In free tissue transfer surgery all flaps are subjected to a primary ischemic episode prior to reperfusion. Some flaps may fail due to a second ischemic insult in the postoperative period. The maximum allowable time for salvage of such failing flaps is referred to as the secondary critical ischemia time. Unilateral abdominal island skin flaps based on the superficial inferior epigastric vessels were raised in 96 Sprague-Dawley rats. Animals were divided into 24 groups of four rats each. Normothermic ischemia was produced by applying microvascular clamps to the vascular pedicles. The flap groups were subjected to combinations of primary ischemia, reperfusion, and secondary ischemia. Flap survival was assessed on the seventh postoperative day. Flap survival decreases significantly with increased primary and/or secondary ischemia time and decreased reperfusion period. Moreover, a longer primary ischemia and/or shorter reperfusion decrease the tolerance of the flap to a second ischemic insult.
(Arch Otolaryngol Head Neck Surg. 1991;117:1360-1364)
Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Babajanian, Turk, Biller, and Urken) and General Surgery, Division of Plastic Surgery (Drs Zhang and Weinberg), Mount Sinai Medical Center, New York, NY.
Footnotes
Accepted for publication May 16, 1991.
Presented at the 94th Annual Meeting of American Academy of Otolaryngology—Head and Neck Surgery, September 10, 1990, San Diego, Calif.
Reprint requests to the Department of Otolaryngology—Head and Neck Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029 (Dr Babajanian).
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