Chapter 7 Abstract Background Partial flap loss is a multifactorial pathophysiological process that occurs after free tissue transfers such as in DIEP flap surgery. Despite tremendous progress made in flap design based on increased anatomical knowledge of the lower abdomen, improvement in technique partial flap loss and/or fat necrosis remains a problem in reconstructive breast surgery. The aim of this experimental study is to investigate the effect of ischemia and reperfusion injury on the extent of partial flap loss. Methods In a mouse transverse rectus abdominus muscle (TRAM) flap model, flaps were exposed to increasing ischemia periods to assess ischemia‐reperfusion (IR) damage. The animals were assigned randomly to three groups: (1) nonischemic control, (2) 30 minutes of ischemia, and (3) 60 minutes of ischemia. Partial flap loss was expressed in percentages, and pattern of flap loss was described. Significance was set at a p‐value of 0.05. Results In group 1, partial flap loss was 10.7±4.3%. Partial flap loss occurred mostly in the so‐called classical zone IV as anticipated. The area of partial flap loss was significantly increased when the flaps were subjected to IR injury (P=0.045). Partial flap loss always occurred in a distal to central fashion. Conclusions We propose a more physiological zone classification in flaps (e.g. the DIEP flap) that divides a flap in three zones. IR injury is a significant detrimental factor in partial flap loss, and further endeavors aimed at reducing partial flap loss and/or fat necrosis could be based on a more pharmacological approach. 100
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