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A Novel Experimental Rat Skin Flap Model That Distinguish Between Venous Congestion and Arterial Ischemia: the Reverse U-Shaped Bipedicled Superficial Inferior Epigastric Artery Flap
Noriko M. Matsumoto, M.D.1, Masayo Aoki, M.D., Ph.D.1, Junichi Nakao, M.D.1, Hiroki Umezawa, M.D., Ph.D.1, Satoshi Akaishi, M.D., Ph.D.1, Yoshihiro Takami, M.D., Ph.D.2, Wei-Xia Peng, M.D., Ph.D.3, Ryuji Ohashi, M.D., Ph.D.3, Zenya Naito, M.D., Ph.D.3, Rei Ogawa, M.D., Ph.D.1.
1Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan, 2Tokyo Rosai Hospital, 4-13-21 Omori-minami, Ota-ku, Tokyo, Japan, 3Department of Integrated Diagnostic Pathology, Graduate School of Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan.

Purpose
A rat skin flap model has been used in numerous studies with evaluation of the flap survival rate. Flap necrosis is caused by mixed arterial and venous insufficiency. However, there is no flap model that can clearly distinguish between ischemia and congestion.
Methods
We created a new rat skin flap model to distinguish between venous congestion and arterial ischemia. Rats were divided into three groups: control (n=3), ischemia (n=10), and congestion (n=10). A reverse U-shaped bipedicled superficial epigastric artery (SIEA) flap was elevated. On the opposite side to the pedicle, the artery was ligated as an ischemia model (A-V+) and vein was ligated as a congestion model (A+V-). The flap was returned to the original site and sutured. Surrounding neo-vascularization was blocked by polyurethane film. The flap survival rate was evaluated on the third postoperative day and statistical analysis (one-way ANOVA) was performed.
Results
The mean flap survival rate was 100%, 61.8% (56.9-67.1%), and 42.3% (35.7-48.7%) in the control, ischemia, and congestion groups, respectively (p<0.001) (Fig. 1). Our results demonstrated that the present flap could significantly distinguish between ischemia and congestion.
Conclusions
This flap model is simple and has a consistent flap survival rate. We believe that this flap model can be used to assess the benefits of various pharmacological agents on the survival pattern of skin flaps.
Fig. 1. The mean flap survival rate.


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