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2016 ; 4
(2
): e617
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Keystone Island Flap: Effects of Islanding on Vascularity
#MMPMID27014546
Lo CH
; Nottle T
; Mills J
Plast Reconstr Surg Glob Open
2016[Feb]; 4
(2
): e617
PMID27014546
show ga
Based on his clinical observations the "red dot sign" and hyperemic flare, Behan
has advocated the superior vascularity of the island flap design for at least 2
decades. The aim of this study was to determine whether (1) surgical islanding of
a flap alters the vascularity or blood supply of the flap and (2) these changes
in blood supply explain Behan's clinical observations of "red dot sign" and
hyperemic flare. METHODS: Patients undergoing local island fasciocutaneous flaps
or anterolateral thigh fasciocutaneous free flaps were recruited for this trial
from a single institution over a 10-month period (September 2013 to July 2014).
Three adjacent specimens of skin and subcutaneous fat (control, non-island, and
island) were harvested from each patient at various stages of their surgery for
histological assessment. A pathologist reviewed randomized specimens for
microvascular variables, including arteriole wall thickness, arteriole diameter,
venule wall thickness, and venule diameter. RESULTS: Thirteen patients (with 14
sets of specimen) were recruited for this study. When compared with the control
state, both arteriole diameter and venule diameter in island flaps were
significantly increased. CONCLUSIONS: These results validate Behan's clinical
observations of "red dot sign" and hyperemic flare. Further studies are required
to directly compare island and non-island flap designs.