Retalho de padrão axial da artéria torácica lateral para reconstrução de lesão cutânea em região de cotovelo de cão: Relato de caso / Use of lateral thoracic axial pattern flap to repair cutaneous defect in a dog elbow: Case report

Os retalhos cutâneos são técnicas de escolha para reconstrução de grandes defeitos. Objetivou-se relatar o emprego do retalho de padrão axial da artéria torácica lateral em paciente com ferida cirúrgica ocasionada imediatamente após exérese de neoformação na região da articulação do cotovelo. Foi atendido paciente canino macho, 10 anos, pesando 12 kg, apresentando neoformação em tecidos moles, de grande volume, localizada na região medial do cotovelo. Como tratamento definitivo, implementou-se a exérese marginal da neoplasma seguida de reconstrução com a técnica de retalho de padrão axial da artéria torácica lateral. A técnica possibilitou completa síntese e oclusão do defeito, obtendo-se ótima recuperação pós operatória, não sendo observada deiscência de sutura ou necrose do retalho. Conclui-se que a implementação do retalho da artéria torácica lateral foi uma técnica viável na reconstrução em cotovelo após a exérese do neoplasma no paciente relatado, observando resultados satisfatórios quanto aos aspectos funcionais e cosméticos, após o período cicatricial.

Skin flaps are suitable methods of wound closure in large cutaneous defects. I The present study aims to report the use of lateral thoracic axial pattern flap to repair an elbow wound secondary to a neoplasm resection. A 10-year-old male dog weighing 12 kg was presented with a large soft tissue neoplasm in the medial aspect of the elbow. The patient underwent surgical resection of the neoplasm using the lateral thoracic cutaneous flap to achieve a complete defect closure, resulting in an excellent postoperative wound healing without suture failure or skin flap necrosis. It is concluded that the implementation of the lateral thoracic artery flap was a viable technique in elbow reconstruction after neoplasm excision in the reported patient, with satisfactory results regarding functional and cosmetic aspects after the healing period.

Retalho de padrão axial da artéria torácica lateral para reconstrução de lesão cutânea em região de cotovelo de cão: Relato de caso / Use of lateral thoracic axial pattern flap to repair cutaneous defect in a dog elbow: Case report

Os retalhos cutâneos são técnicas de escolha para reconstrução de grandes defeitos. Objetivou-se relatar o emprego do retalho de padrão axial da artéria torácica lateral em paciente com ferida cirúrgica ocasionada imediatamente após exérese de neoformação na região da articulação do cotovelo. Foi atendido paciente canino macho, 10 anos, pesando 12 kg, apresentando neoformação em tecidos moles, de grande volume, localizada na região medial do cotovelo. Como tratamento definitivo, implementou-se a exérese marginal da neoplasma seguida de reconstrução com a técnica de retalho de padrão axial da artéria torácica lateral. A técnica possibilitou completa síntese e oclusão do defeito, obtendo-se ótima recuperação pós operatória, não sendo observada deiscência de sutura ou necrose do retalho. Conclui-se que a implementação do retalho da artéria torácica lateral foi uma técnica viável na reconstrução em cotovelo após a exérese do neoplasma no paciente relatado, observando resultados satisfatórios quanto aos aspectos funcionais e cosméticos, após o período cicatricial.

Skin flaps are suitable methods of wound closure in large cutaneous defects. I The present study aims to report the use of lateral thoracic axial pattern flap to repair an elbow wound secondary to a neoplasm resection. A 10-year-old male dog weighing 12 kg was presented with a large soft tissue neoplasm in the medial aspect of the elbow. The patient underwent surgical resection of the neoplasm using the lateral thoracic cutaneous flap to achieve a complete defect closure, resulting in an excellent postoperative wound healing without suture failure or skin flap necrosis. It is concluded that the implementation of the lateral thoracic artery flap was a viable technique in elbow reconstruction after neoplasm excision in the reported patient, with satisfactory results regarding functional and cosmetic aspects after the healing period.

Angiosome study of the first digital feet space, for reconstruction of the digital tip

Background: The concept of angiosome explains the anatomical variations that exist between the vessels of different regions of the body and helps to understand the contributions of arterial blood supply to the skin and adjacent structures, dividing the human body into three-dimensional vascular blocks.Methods: This was an observational and descriptive study. In both lower extremities of 5 corpses with adequate tissue preservation in the operating room attached to the teaching area of the National Institute of Forensic Sciences in Mexico City. Angiosome study of the medial neurocutaneous flap of the second toe of both feet was performed.Results: The average, in centimeters, of the surface of the flaps was 1.57 cm x 2.47 cm, the average diameter of the inter-metatarsal digital artery was 1.1 millimeters and the average diameter of the veins draining the angiosome was 1.4 millimeters. The most constant anatomy was that of the nerve, which was present in all cases, with the digital nerve forming the neurosome of the flap.Conclusions: To obtain optimal results in microsurgery transfers, it is necessary to have a technique that is quick for harvesting the flap and with adequate systematization so as not to injure the neurovascular bundle, this is achieved through complete anatomical knowledge, without forgetting the main variants.

Internal relationships within axial pattern flaps between the angiosome and perforasome / 中华整形外科杂志

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.

Dual Perforator Flap for Reconstruction of Large Sacral Defects: Superior Gluteal Artery Perforator Super-Flap with Parasacral Perforator

The superior gluteal artery perforator flap technique has increasingly been used for soft tissue defects in the sacral area following its introduction nearly 25 years ago. Advantages in covering sacral defects include muscle sparing, versatility in design, and low donor side morbidity. The bilateral superior gluteal artery perforator flap procedure is planned in cases of large sacral defects that cannot be covered with the unilateral superior gluteal artery perforator flap. Here, we report two cases of large sacral defects in which patient factors of poor general health, such as old age, pneumonia, and previous operation scar, led to use of a large unilateral superior gluteal artery perforator super-flap with parasacral perforator. The approach was utilized to reduce the operation time and prevent unpredictable flap failure due to the large flap size. Even though the parasacral perforator was included, the versatility of the large superior gluteal artery perforator flap was preserved because sufficient perforator length was acquired after adequate dissection.

Clinical significance of the angiosome-based revascularization strategy for endovascular procedures in elderly patients with diabetic foot disease / 中华老年医学杂志

Objective To investigate the clinical significance of compensatory angiogenesis and the angiosome-based revascularization strategy for endovascular procedures in treating infrapopliteal critical limb ischemia in elderly diabetic patients.Methods A retrospective study of 194 patients with diabetic feet (Fontaine Ⅳ) who had undergone endovascular procedures at our hospital from January 2005 to December 2014 was performed.Based on the angiosome concept,all subjects were classified into the direct revascularization group (DR group),the indirect revascularization through collaterals group (IR-tc group) and the indirect revascularization without collaterals group (IR-wc group).After one-year follow-up,the therapeutic effects were analyzed and compared between the three groups.Results During the one-year follow-up,the rate of unhealed ulcers,the re-intervention rate and the rate of major adverse limb events (MALE) were higher in the IR-wc group than in the DR and IR-tc groups (P=0.000 and 0.000,P=0.025 and 0.013,P=0.014 and 0.023,respectively).The IR-wc group presented a lower limb salvage rate as compared with those in the DR and IR-tc groups (P=0.011 and 0.027).Patients with a single recanalized branch had a higher rate of unhealed ulcers than those with multiple recanalized branches in the IR-wc group (93.9％ vs.71.0％,P=0.015).Conclusions The angiosome-based revascularization strategy has shown important value in guiding endovascular procedures for patients with diabetic foot disease and,in particular,the compensatory angiogenesis approach appears to be critical in generating favorable short-term clinical outcomes in the treatment of diabetic foot disease.

Revelation of angiosome theory in the study of meridian point structure / 中国针灸

Meridian point and angiosome are the concepts in two different medical systems with a thousand year in between. In comparison between the angiosome concept and the meridian point structure characteristics in(), it is found that angiosome and meridian point are distri-buted in the head, face, trunk and four limbs. Both of them are the complex tissues of stereostructure. The essential structure of them is the vessel for blood circulation and the relevant vascular grades are of equity relationship. Both meridian point and angiosome are distributed segmentally and the number of perforator vessels is very near to that of meridian points. It is indicated on the basis of analysis that both of them are of high similarity in terms of human body structure and it is further discovered that the study achievement on angiosome not only benefits the understanding of traditional literature of meridian point, but also contributes to the deep research on the structural morphology of meridian point in terms of modern science and technology.

Endovascular therapy based on Angiosome concept for critical lower limb ischemia / 中华普通外科杂志

Objective To evaluate the clinical value of endovascular therapy based on Angiosome concept in critical limb ischemia (CLI) patients.Methods A retrospective study was undertaken in 62 patients (62 limbs) diagnosed as critical limb ischemia (Rutherford class 5/6) and received percutaneous transluminal angioplasty from July 2011 to October 2013.Patients were divided into direct (35 patients) and indirect (27 patients) groups depending on whether feeding artery flow to the site of ulcer was successfully achieved or not based on the angiosome concept,and the between-group clinic outcomes including preoperative and postoperative ankle-brachial index (ABI),ulcer healing,and the rates of freedom from amputation were compared and analyzed.Results There were no significant difference between two groups for ABI pre-operatively (0.16 ±0.26 vs.0.15 ±0.28; P =0.885) and post-operatively (0.82 ± 0.26 vs.0.81 ±0.24; P =0.877).During follow-up,the healing rate of ischemia ulcer in patients without amputation at 1 year (91％ vs.74％ ; P =0.027) were significantly higher in the direct group than in the indirect group.There was no difference between two groups for healing time (162 ±49) d vs.(160 ±46) d; P =0.950).The rates of freedom from amputation at 1 year (84％ ±3％ vs.76％ ±4％ ; P =0.025) and 2 years (79％ ±4％ vs.72％ ±4％ ; P =0.031) were significantly higher in the direct group than in the indirect group.Conclusions Endovascular therapy based on Angiosome concept in CLI patient is an effective procedure with satisfactory clinic outcomes,contributing to healing of ischemia ulcer and increase amputation-free rate.

Analysis of Intermediate Term Results of Short Vein Bypass Graft in the Patient with Critical Limb Ischemia

PURPOSE: Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB. MATERIALS AND METHODS: From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type. RESULTS: There were 11 males and 16 females and the mean age was 66.6+/-12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00) CONCLUSION: The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.

Clinical Comprehension and Application of Angiosome Concept in Critical Limb Ischemia / 대한혈관외과학회지

Ian Taylor introduces the angiosome concept, separating the body into distinct three-dimensional blocks of tissue fed by source arteries. Understanding the angiosome of the foot and ankle and the interaction among their source arteries is clinically useful in surgical bypass or endovascular treatment of the foot and ankle, especially in the critical limb ischemia. The angiosome concept may provide useful information on the human vascular anatomy and related pathology, with specific applications in surgical and endovascular treatment. This knowledge may become particularly beneficial in critical limb ischemia, while treating advanced atherosclerotic disease. The implementation of angiosome derived strategies in critical limb ischemia may afford encouraging wound healing and limb salvage rates for both, surgical bypass or endovascular techniques. However, the angiosome concepts have several limitations, and thus, large comparative studies are necessary to support these concepts. This paper reviews the available literature on this revascularization strategy and focuses on the potential benefit of angiosome-guided treatment for patients of critical limb ischemia.