ABSTRACT
The authors reviewed the concepts of the axial pattern flap, angiosome and perforasome, and analyzed the anastomosis and hemodynamic characteristics between the angiosome and the perforasome. Results: (1) Axial pattern flaps can be designed either in the angiosome or in perforasome. The difference is the pedicle and vascular axis. (2) The middle perforator should be the first choice as the pedicle for multi-perforators cross-territory flap, and the axial direction of the flap should be the same as that of the source artery. (3) Avoid as much as possible nutrient large flap with small blood vessels, that is, using a perforating vessel as a pedicle to cross-zone support to an angiosome flap. (4) The position of vascular pedicle and venous drainage is more important than the size and number of blood vessels. It is proposed that the transformation and reconstruction of the axial vascular in the multi-perforated cross zone flap to establish a new blood circulation system is a research hotspot and challenges in the study of anatomy. It is necessary to work closely with the surgeons.
ABSTRACT
Objective To investigate the effects of DMOG on the microcirculation of the choke-area and the survival of the cross-boundary flap in rats via tail vein injection.Methods Rats with ischemic three-territory perforator flaps on the dorsum were treated with DMOG at a dosage of 40 mg/kg body weight via tail vein injection at 1 day before surgery(day-1),the time of surgery(day 0),1 day after surgery(day 1),2 days after surgery(day 2) and 3 days after surgery(day 3).Control group received sterile saline at the same time points and same dosage via tail vein injection.① Draw materials from the choke-area at day 1,day 3 and day 7,HE stain was used to compare the diameter size of the artery and vein at the same site.② Western blotting to check the expression of PCNA and HIF-1α,ELISA to detect the content of PCNA,HIF-1α,SDF-1α and VEGF at day 7.③At day 7,measure the survival area of the flap and observe the vessel of the flap by lead oxide-gelatine technique.Results ① There was a greater survival rate of (96.3 ± 5.1)％ in the treatment group than in the control group with (73.9 ± 5.8)％ at day 7 (P ＜ 0.05).② The diameter size of the arterioles and venules were dilated in both groups until postoperative days 7.But the treatment group was more expanded than the control group at day 3(2.20 ± 0.26 vs.1.50 ± 0.20,P ＜ 0.05) and day 7(3.67 ± 0.35 vs.2.03 ± 0.15,P ＜ 0.05).③ The skin expression of PCNA and HIF-1α in the treatment group were greater than the control group(P ＜ 0.05) at day 7.④ The content of skin PCNA in the treatment group and control group were(8.95 ± 0.71) ng/mg and (4.15 ± 0.72) ng/mg,HIF-1α were(5.04 ± 0.50)ng/mg and (2.98 ± 0.29) ng/mg,SDF-1α were (2.91 ± 0.61) ng/mg and (1.39 ± 0.62) ng/mg,and VEGF were(2.17 ± 0.41) ng/mg and (0.95 ± 0.44) ng/mg,respectively.The treatment group was greater than the control group (P ＜ 0.05).Conclusion DMOG can improve the microcirculation of the choke area,and then increase the survival of the perforator skin flaps in rats via tail vein injection.
ABSTRACT
Objective To establish a mouse ’ s cross-territory ear flap that enables chronic , in-vivo observation of the change of vascular morphology .Methods 30 ICR mice, weighing 25~40 g, were used for this study .Commercial depilatory cream was used to first remove the hair of the mice , after which the vascular pattern in the ears was investigated . According to the observation of the vascular pattern in the mouse ’ s ear, the eye scissors were used the sever the outer 2/3 of the base of the ear , in which process a ear ’ s flap based on a vascular pedicle but crossed three vascular territories was created.After the creation of the flap , the mice were placed on an automatic controlled movable machine with the ear ’ s flaps spread over a customized Plexiglas .Then the flaps were photographed under the stereoscope ( ×25) at the following time points:1,2,3,5,7,10,14,21,30 d.the necrosis of the flap, and the morphological change of the vessels within theflap were analyzed .Results The ICR mouse ’ s ear was supplied three angiosomes , which were respectively named as the cephalic , median and caudal angiosomes from inside out .Five days after the flap’s creating, necrotic rate of(15 ±7)%was developed .The choke vessels between the medial and median angiosomes expanded rapidly in diameter , reaching the plateau 10d after flap creation, resulting the dilated choke veins and arteries at their peak being 3.9 ±0.5 and 3.5 ±0.7, respectively, than their initial sizes.The diameter of the choke veins began to shrink at approximately 10d, stabilizing after 21d.The diameter of the choke arteries plateaued and stabilized at around 10d.Conclusion ①after harvest of extended flap, the dilation of veins seemed to passive , whereas the dilation of arteries seemed to active;②the number of the choke vessels between the dynamic and potential territories that are involved in dilation and extent of the dilation are much smaller than that of the choke vessels between the anatomic and dynamic territories;③the mouse ’ s ear flap is an excellent model of further study of mechanism underlining the dilation of choke vessels and for the screening of vasoactive drugs that augment the survival of the large flap .