In flap surgery used frequently in the scope of plastic surgery, surgeons sometimes have been experienced the flap necrosis, which is caused by poor vascular supply due to inadequate design of flap, gravity, twisting or kinking of flap, pressure, infection and underlying hematoma, and so on, it leads to undesirable postoperative result. Among them, hematoma--related flap necrosis is the most unpredictable and frequent, thus it is very urgent to grope its cause and the way to overcome this complication.
But precise mechanism of flap necrosis has not been revealed yet, the mechanism of hematoma related flap necrosis which is explained until now are; increased internal pressure, constituent of homolysate. But the way to overcome hematomarelated flap necrosis is hardly reported. Though they say early surgical removal of hematoma will prevent most of flap necrosis, the previous studies have not reported the other nonsurgical method and the adequate time of removal of hematoma. So the purpose of this study is to describe; What is the mechanism of flap necrosis due to underlying hematoma. What method of removal of hematoma will increase the flap survival. When the hematoma should be removed to increase the flap survival.
The results of the experiment are follows;
1) Flap necrosis was severe significantly in blood, blood clot and hemoglobin injected group.
2) Flap necrosis due to underlying hematoma is thought to be caused by the toxic effect of red blood cell or hamolysate of red blood cell.
3) Surgical removal group of the underlying hemotoma had a significant better result in survival of flap than no removal control, hydrogen peroxide irrigation and urokinase injected group.
4) Surgical removal of the underlying hematoma carried out within 6 hours after injection of blood beneath the flap made no statistically significant difference in flap survival as compared with no blood control group. Surgical removal of hematoma 6 hours after blood injection or other nonsurgical methods of revealed in rather better result in flap survival as compared with no removal control group, but there was a statistically significant difference in survival compared with no blood control group.
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