Pittet Brigitte, Quinodoz Pierre, Alizadeh Navid, Schlaudraff Kai-Uwe, Mahajan Ajay L
Geneva, Switzerland From the Department of Plastic and Reconstructive Surgery, University Hospitals of Geneva.
Plast Reconstr Surg. 2008 Dec;122(6):1681-1689. doi: 10.1097/PRS.0b013e31818cbef1.
Outcome of arterialized venous flaps is quite varied. The authors' initial experiments showed that a good vascular bed contributes significantly to survival of the flap. In continuation of these experiments, this study aimed to understand the influence of architectural variations on flap outcome.
Fasciocutaneous flaps were designed on the ears of New Zealand rabbits, and the animals were randomized into four groups having flaps that used the larger anterior marginal vein (1.3 mm) or the smaller central vein (0.6 mm) for arterial inflow, with or without isolation of the flap from its bed with a silicone sheet. Flaps were observed for area of flap survival and vasculature was assessed by microangiography.
Using the smaller central vein for arterial inflow (n = 15), arterialized venous flaps had an excellent outcome, with good flap survival in 100 percent of the animals (survival of >85 percent of flap area), and a mean flap survival area of 99.4 +/- 1.6 percent. Even when neovascularization was prevented by isolation of the flaps (n = 14), 92 percent of central vein flaps showed good survival, with a mean flap survival area of 93.3 +/- 7.3 percent, which was significantly better than that of anterior marginal vein flaps (n = 22), which showed good flap survival in only 27 percent of the animals (mean flap survival area, 76.4 +/- 12.1 percent).
Survival of arterialized venous flaps is optimized by using smaller-caliber veins for inflow and reserving larger-caliber veins for outflow. This regulates inflow and avoids high blood pressure, and arterialized venous flaps behave as physiologic flaps do, by not relying on neovascularization for survival.
动脉化静脉皮瓣的结果差异很大。作者最初的实验表明，良好的血管床对皮瓣存活有显著贡献。在这些实验的延续中，本研究旨在了解结构变化对皮瓣结果的影响。
在新西兰兔的耳朵上设计筋膜皮瓣，将动物随机分为四组，其皮瓣使用较大的前边缘静脉（1.3毫米）或较小的中央静脉（0.6毫米）进行动脉血流供应，皮瓣与床面之间有或没有用硅胶片隔离。观察皮瓣的存活面积，并通过微血管造影评估血管系统。
使用较小的中央静脉进行动脉血流供应时（n = 15），动脉化静脉皮瓣有出色的结果，100%的动物皮瓣存活良好（皮瓣面积存活>85%），平均皮瓣存活面积为99.4±1.6%。即使通过皮瓣隔离阻止新生血管形成（n = 14），92%的中央静脉皮瓣仍显示良好存活，平均皮瓣存活面积为93.3±7.3%，这明显优于前边缘静脉皮瓣（n = 22），后者仅27%的动物皮瓣存活良好（平均皮瓣存活面积，76.4±12.1%）。
通过使用较小口径的静脉进行血流供应并保留较大口径的静脉用于流出，可优化动脉化静脉皮瓣的存活。这调节了血流并避免高血压，并且动脉化静脉皮瓣的行为与生理性皮瓣相同，即不依赖新生血管形成来存活。
