Systematic injection patterned-technique of one-per-mil tumescent solution for perforator-based skin flap: Is it better than the random patterned-technique?

Abstract

The aim of the study is to compare the systematic injection patterned-technique of 1-permil tumescent solution versus the random patterned-technique. Several incidences of perforator flap necrosis have been encountered with tumescent technique. Among the possible causes, the most probable cause is the injury of perforator artery due to the multipassing needle injections. Thus, an evaluation regarding the needle injection pattern needs to be done in order to avoid necrotic flap incidence. A randomized controlled experimental study was conducted on both groins of 20 healthy Wistar stained-Rattus novergicus weighing 220 to 270 g. A comparison of a systematic injection pattern and a random injection pattern was performed. Three mL of 1-per-mil tumescent solution was injected subcutaneously before elevation of the islanded groin flap. Clarity of the operative field along with the size of the pedicle were recorded. The photos of survival area of the skin flap on postoperative day 7 were analyzed using Analyzing Digital Images. Totally bloodless operative field was observed in all subjects. Three out of 19 flaps in group A (15.78%) and 4 out of 18 flaps in group B (22.22%), were found to be necrotic, either total or partial. No significant difference (P > 0.05) was found between the injection technique groups, in terms of flap necrosis. Although the 1-per-mil tumescent technique is advantageous in a way that it provides a totally bloodless operative field, the systematic injection patterned-technique was not found to be more superior compared to the custom random patterned-multi-passing needle injection technique.