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September 1990

The Effect of Venous Obstruction in Infected Pedicle Flap

Author Affiliations

From the Department of Surgery, State University of New York Health Science Center at Brooklyn (Dr Mann); and the Department of Surgery, Division of Plastic Surgery and Shriners Burns Institute (Dr Phillips); the Departments of Microbiology and Surgery, Shriners Burns Institute (Dr Heggers); the Department of Pathology, Shriners Burns Institute (Dr Linares); Shriners Burns Institute (Ms Traber); and the Department of Surgery and Microbiology, Division of Plastic Surgery and Shriners Burns Institute (Dr Robson), University of Texas Medical Branch, Galveston, Tex.

Arch Surg. 1990;125(9):1177-1180. doi:10.1001/archsurg.1990.01410210103016

• A new model of soft-tissue infection is used to investigate the effect of the local wound environment on the septic focus. Island pedicle flaps were raised on the buttock of 24 adult ewes and multiply inoculated with Staphylococcus aureus. Flaps with bacterial inoculation, without compromise of venous outflow, showed distal necrosis (mean ± SEM percent of surface area, 25.8% ± 8.6%) and developed septic foci with bacterial counts one log less than the amount injected. Flaps with inoculation and venous outflow obstruction underwent subtotal necrosis (mean percent of surface area, 73.3% ±11.2%) and had counts two logs higher than the nonobstructed flaps but without discrete septic foci. Flaps without inoculation, with or without venous obstruction, survived completely. Venous outflow obstruction is shown herein to potentiate tissue necrosis by raising bacterial counts in a septic focus and preventing defensive abscess formation by the host.

(Arch Surg. 1990;125:1177-1180)