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Development of a Porcine Model of a Superior Epigastric Artery Based Perforator (SEAP) Free Flap for Microsurgical Training
Abigail Meyers, Jacob Lammers, Brian Figueroa, Mazen Al-Malak, Sonia Kukreja Pandey, Payam Sadeghi, Ryan Khalaf, Diane Jo, R'ay Fodor, Jose Reyes, Ying Ku, Lianne Mulvihill, Varun Kopparthy, Antonio Rampazzo, Bahar Bassiri Gharb
Cleveland Clinic
2023-01-30
Presenter: Abigail Meyers
Affidavit:
Agree with above statement. This project was original work conducted by the medical student and research fellow team under the guidance of the primary investigator, Dr. Bahar Bassiri Gharb.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Purpose
We aimed to assess the feasibility of a porcine abdominal perforator flap model.
Methods
Red and blue latex were injected into subclavian arteries and veins of 10 Yorkshire pig cadavers. Dominant arterial supply to the rectus abdominis, skin, and perforator distribution were evaluated to plan for subsequent live animal studies.
SEAP flaps were procured from 13 Yorkshire pigs (IACUC #00002418). Once islanded on the vascular pedicle, indocyanine green (ICG) angiography was performed to quantify flap perfusion. Median pixel brightness was determined utilizing ImageJ software (Bethesda, MD, USA). Normalized median pixel brightness was computed for three static images of each flap to generate quantitative scores.
Flap size, weight, number of perforators, pedicle length, and ICG intensity were analyzed.
Results
Anatomical studies
The superior epigastric artery was the dominant arterial supply to rectus muscle and overlying tissue. Two rows of perforators, medial and lateral, were identified. Perforators were consistently located close to the nipples, which were thereafter used as landmarks for flap design.
Live animal studies
A median of 5 [4-5] perforators per flap were included. Average flap weight was 188±49g (104-282g) and dimensions were 21.3±1.7 by 6.8±0.5 cm. The lower 4 ribs were removed to lengthen the vascular pedicle. Average pedicle length was 10.2±1.2cm. ICG angiography revealed well-perfused flaps with a mean fluorescence score of 47.5±13.2.
Conclusion
The porcine model of a SEAP flap offers relevant similarities to the human deep inferior epigastric artery perforator flap. It is a reliable model for perforator flap dissection for microsurgical training.
