Abstract
Necrosis of the distal portion of a flap is a common complication, but there still is some dispute as to the cause. Some investigators feel that venous inadequacy is the major factor, while others blame arterial insufficiency. In attempts to elucidate the problem, many experiments have been reported, but most were concerning rats. The skin of a rat has a vasculature so rich that necrosis of the distal part of the flap was not always obtainable, especially when the load was less than critical.
With these points in mind, we investigated the relationship between necrosis and vascular insufficiency, after treatment of the vascular pedicle, using flaps designed such that constant necrosis in the distal portion is possible.
This study showed arterial insufficiency to be more responsible than venous inadequacy for necrosis of the pedicle island flap. When the flap was so designed to allow both arterial insufficiency and venous inadequacy, the blood flow through the vascular pedicle was considered to be balanced, and the survival rate appeared to be the same as in control. However, the worst survival rate was observed in. this group.
Based on findings regarding survival of the vascular pedicle island flap, it can be said that arterial insufficiency has a greater influence on necrosis than venous inadequacy, and when there is a low blood flow volume through the vascular pedicle, the survival rate worsened even though the blood flow was balanced.
