ISSN : 2146-3123
E-ISSN : 2146-3131

Effect of Botulinum toxin-A Injected to Muscle Tissue on Perfusion and Survival of Fasciocutaneous Single Perforator-pedicled Propeller Flap in Rats
Umut Zereyak1, Neşe Kurt Özkaya2, Zekiye Hasbek3
1Department of Plastic Reconstructive Aesthetic Surgery, Sivas Numune Hospital, Sivas, Turkey
2Department of Plastic Reconstructive Aesthetic Surgery, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
3Department of Nuclear Medicine, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
DOI : 10.4274/balkanmedj.galenos.2019.9.44

Background: In plastic surgery practice, fasciocutaneous single-perforator-pedicled propeller (SPPP) flap is a
preferred procedure; however, its survival rate is below than expected, especially in flaps with a big rotation arc.
When botulinum toxin-A (BoTA) is injected into the muscle tissue that the perforator pedicle is arisen, the tonus
of pertinent muscle can reduce and the blood flow of its perforator pedicle can increase. Therefore this procedure
can improve the survival rate of SPPP flap.
Aims: To evaluate the effect of BoTA injected with ultrasonographic guidance into the muscle tissue that the
perforator pedicle is arisen from one month ago on the perfusion of flap scintigraphically and the survival rate of
SPPP flap in a rat model.
Study Design: Animal experiment.
Methods: Three study groups were receiving BoTA (16IU-0.4- mL), normal saline (0.4-mL), and no study drug
one month ago before flap surgery. Injections were performed under ultrasonography guidance. Flaps were
elevated fasciocutaneously over the right 2nd perforator pedicle, under the corneous, with a surgical loupe and
microsurgery tool and were rotated clockwise 180°. Then the scintigraphic measurements were obtained after
flap elevations in the study groups, including the whole-body and flap perfusions in the study rats. The
involvement rate presents the ratio of flap perfusion to whole-body perfusion. Flaps were sutured back to the
abdominal wall at the latest twisting angles. With standard photographs taken in all the groups on day 8 after the
operation, whole and necrotic flap areas were calculated.
Results: Scintigraphically the involvement rate (the ratio of flap perfusion to whole-body perfusion) of the flaps
in the BoTA group were found significantly higher than those in the other groups (p<0.05). The area of a flap in
the BoTA group on day 8 post flap suturing was found to be significantly higher than those in the other groups
(p<0.05). The area of a necrosis and the percentage of necrosis on day 8 post flap suturing in the BoTA group
was found significantly lower than those of the sham and null groups (p<0.05).
Conclusions: In a rat model, if with the ultrasonographic guidance, BoTA is injected to the muscle which
perforator of the prospective SPPP flap originated and flap surgery is performed one month later after this
injection, the perfusion of SPPP flap increases scintigraphically and this improves flap survival and reduces its
necrosis.

Keywords : Propeller-perforator-pedicled flap, flap necrosis, scintigraphy, ultrasonography, botulinum toxin-A

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