Avci Gulden, Akan Mithat, Akoz Tayfun, Kuzon William, Gul Aylin Ege
Department of Plastic and Reconstructive Surgery, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey.
Microsurgery. 2009;29(3):218-25. doi: 10.1002/micr.20609.
We tested the hypothesis that the intrinsic vascular plexus of the motor nerve could support viability in a rat hindlimb muscle flap. In a preliminary study, we examined the course and vascularity of the sciatic nerve, the peroneal nerve, and the peroneous longus muscle in the rat hindlimb via anatomic dissection, microangiography, and histologic study (n = 10 animals). On the basis of this examination, the peroneous longus muscle was chosen as our experimental model in this study. In 12 animals, the peroneus longus was acutely elevated, which severed all tendinous and vascular structures, this left the muscle pedicled on the motor nerve only (Group I). Animals in Group II underwent a staged elevation of the flap with division of the vascular pedicle, the tendon of insertion, and the tendon of origin during separate procedures that were 5 days apart (n = 12). Muscle viability was evaluated by gross inspection, measurement of muscle weight and length, nitroblue tetrazlium (NBT) staining, microangiography, and histology. NBT staining demonstrated that immediate elevation of the peroneus longus muscle flaps led to an average necrotic area of 80.6% +/- 9.8% (Group I). A significant improvement in viability was observed for muscle flaps of animals in Group II, with peroneus longus muscle necrosis averaging 25.6% +/- 9.3%. Microangiography demonstrated that the intrinsic vascularity of nerve was increased dramatically in Group II. These data support the hypothesis that the intrinsic vascular plexus of the motor nerve of a skeletal muscle can support at least partial viability of a muscle flap. However, this vascular axis is inadequate to support complete viability of a muscle flap if the flap is elevated immediately. If a staged elevation affects a surgical delay, the viability of a muscle flap elevated on a neural pedicle can be increased significantly. With adjustments in the delay procedure, this strategy may allow transfer of muscle flaps when maintenance or reconstitution of the primary vascular axis is not possible.
我们验证了运动神经的内在血管丛能够维持大鼠后肢肌皮瓣存活的假说。在一项初步研究中，我们通过解剖、微血管造影和组织学研究（n = 10只动物），检查了大鼠后肢坐骨神经、腓总神经和腓骨长肌的走行及血管分布。基于此项检查，本研究选用腓骨长肌作为实验模型。在12只动物中，将腓骨长肌急性掀起，切断所有肌腱和血管结构，使肌肉仅以运动神经为蒂（I组）。II组动物分阶段掀起皮瓣，在间隔5天的不同手术过程中分别切断血管蒂、止点腱和起点腱（n = 12）。通过大体观察、测量肌肉重量和长度、硝基蓝四氮唑（NBT）染色、微血管造影和组织学检查评估肌肉活力。NBT染色显示，腓骨长肌皮瓣立即掀起后平均坏死面积为80.6%±9.8%（I组）。II组动物的肌皮瓣活力有显著改善，腓骨长肌坏死平均为25.6%±9.3%。微血管造影显示，II组神经的内在血管显著增加。这些数据支持了骨骼肌运动神经的内在血管丛能够至少维持肌皮瓣部分存活的假说。然而，如果皮瓣立即掀起，该血管轴不足以维持肌皮瓣的完全存活。如果分阶段掀起涉及手术延迟，则以神经蒂掀起的肌皮瓣活力可显著提高。通过调整延迟程序，当无法维持或重建主要血管轴时，该策略可能允许肌皮瓣的转移。
