Preoperative donor zones preparation of perforant flaps by training perforant vessels with negative pressure

Trofimov, N. and Kryshen, V. and Korpusenko, I. and Nor, N. and Korpusenko, E. and Makarenko, A. (2022) Preoperative donor zones preparation of perforant flaps by training perforant vessels with negative pressure. Georgian Medical News = Медицинские новости Грузии, No 6 (327). pp. 27-31. ISSN 1512-0112

Text Грузинский журнал №6 2022 P. 27-31.pdf Download (545kB)

Abstract

One of the key factors in achieving favorable treatment outcomes when planning reconstructive surgeries using perforant flaps is the choice of recipient vessels. Their identification causes certain difficulties both at the planning stage and during the operation. The aim of the study was to develop the most rational modes of action of negative pressure on the skin of the thigh. For preoperative preparation of the donor zone for the formation of perforant flaps, a local vacuum (VAC - action) was used, which was created using a negative pressure apparatus "AGAT-Dnepr" (Ukraine) by applying it to the anterior surface of the thigh. Preoperative location of perforants was performed using a Flir ONE (USA) thermal imager for smartphones and tablets based on Android. The studies were carried out on a group of healthy volunteers - 35 people: 17 women and 18 men aged 19 to 50 years on the basis of the burn department of the clinic in Dnipro, Ukraine in 2020-21. at the same time at the specified time intervals - 60 seconds (immediately after the action of negative pressure); 20, 30, 60 minutes; after 24 and 48 hours. The highest average number of perforants in the examined patients was observed after 30 minutes of VAC- action - 12.0 (6.0; 12.0), which was statistically significantly higher compared to their number, which was detected after 10 minutes of negative pressure action (p<0.001 ). On average, according to the median values of 12 perforants after 30 minutes, the VAC action remained after 20, 30 and 60 minutes and decreased only after 24 hours. Doubling the period of VAC - action to 60 minutes and no longer led to an increase in the number of perforators. Therefore, the optimal negative pressure time was 30 minutes when up to 10-12 perforants are opened. The smallest average number of perforants was observed at the pressure level P=(-100 mmHg) 24 hours after the VAC-action and at P=(-160 mmHg) 48 hours later. The largest average number of perforants was detected at the pressure level Р= (-130 mmHg) – 10.0 (8.0; 14.0), which was statistically significantly higher compared to their number under the negative impact of pressure Р =(-100 mmHg) (p<0.001). The indicator was constant, the number of perforators was maintained during the entire observation period from 30 minutes to 48 hours. The action of local negative pressure contributed to the opening of perforants of the second and third levels and thus improved blood supply to the donor area. Pressure Р= (-130 mm Hg) and time of 30 minutes was the most optimal mode of action on the skin of the anterior surface of the thigh, since 10 to 14 perforants were determined. The use of local negative pressure against the background of cooling may be useful for "training" the perforant vessels of the donor site for 2-3 days before surgery to reduce postoperative complications.

Item Type:	Article
Uncontrolled Keywords:	Reconstructive surgery, negative pressure, perforant flaps, donor sites, dynamic thermography, blood flow.
Subjects:	General surgery
Divisions:	Departments > Department of General surgery Faculty of Postgraduate Education > Department of Surgery №3 traumatology and orthopedics FPE
Depositing User:	Елена Шрамко
Date Deposited:	13 Oct 2022 11:29
Last Modified:	13 Oct 2022 11:29
URI:	http://repo.dma.dp.ua/id/eprint/7866

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