Revascularization of Arterialized Venous Flaps through a Total Retrograde Reverse Blood Flow: Randomized Experimental Trial of Viability

Abstract

Background: Arterialized venous flaps (AVFs) have been used for reconstruction of soft tissue defects throughout the body. Several different revascularization models have been performed, but venous drainage through the arterial system has not been studied. In our total retrograde reverse blood flow (TRRBF) perfusion model, the arterial blood flow enters through the venous system and venous drainage exits through the arterial system. Methods: We developed a novel experimental model in rabbit ears to evaluate the capacity of TRRBF perfusion pattern to allow AVF viability. The ears were assigned to 3 groups: group 1, total devascularization without revascularization (n = 3); group 2, TRRBF (n = 12); and group 3, conventional AVF (n = 12). The ears were observed during a 30-day follow-up period, and clinical serial assessment of edema, cyanosis, and necrosis was performed. Tissue oxygenation was determined at the beginning and end of the follow-up. Histological analysis was performed. Results: Necrosis was found in 3/3 (100%) ears in group 1, 3/12 (25%) in group 2, and 0/12 (0%) in group 3 (95% CI, 0.505–0.994; P = 0.0001). In group 2, edema was higher (5/12, 41.66%) than in group 3 (0/12, 0%) (95% CI, 0.0135–0.65; P = 0.041). Cyanosis and venous congestion was of greater intensity and duration in group 2 than in group 3 (10.33 ± 4.51 vs 4.5 ± 2.06 d). Conclusions: Although evolution is torpid and prolonged in ears with TRRBF, 9/12 (75%) survived, suggesting that TRRBF can be used as a rescue method.