Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey.
J Plast Reconstr Aesthet Surg. 2013 Jul;66(7):978-86. doi: 10.1016/j.bjps.2013.03.043. Epub 2013 May 2.
Experimental studies have shown that musculocutaneous flaps are not dependent on a major pedicle for survival after 7-8 days, as revascularisation occurs from surrounding well-nourished tissue. However, muscle component loss in myocutaneous flaps after pedicle division has been reported. No study that examines the nature of the vascular ingrowth from underlying beds by blocking the peripheral cutaneous beds has been conducted in musculocutaneous and skin-covered muscle flaps. This study was designed to investigate the origin of the dominant source of neo-vascularisation after interruption of the major vascular supply in island musculocutaneous and island skin-covered muscle flaps by blocking neo-vascularisation from wound edges and the recipient bed.
Twenty-eight rats were divided into four experimental groups. In group I, a cutaneous maximus musculocutaneous island flap (MCIF) was raised, and the wound edges of the flap were blocked with a silastic sheet. In group II, an MCIF was raised, and the recipient bed was blocked with silastic. In group III, an island cutaneous maximus muscle flap (IMF) was raised as an island flap covered by a full-thickness skin graft (FTSG), and the wound margins were blocked with silastic. In group IV, an IMF was raised as an island flap covered by an FTSG, and the recipient bed was blocked with a silastic sheet. On the seventh postoperative day, vessel ligation was performed in each animal. Microangiographic studies and histopathological evaluations were performed 14 days after the first operation.
In microangiographic studies, neo-vascularisation was more prominent in groups II and IV (the groups in which the recipient beds were blocked) than in groups I and III (the groups in which the wound edges were blocked). Upon histopathological examination, the number of vessels was significantly lower in group I and group III than in group II and group IV (p<0.001).
Our findings revealed that neo-vascularisation from either the recipient bed or the wound edges was sufficient to ensure full flap survival in musculocutaneous flaps, and skin-grafted muscle flaps do not need major axial vessels 7 days after flap elevation in rats if the recipient bed or wound edges are well-vascularised. The results also indicated that revascularisation mainly comes from the peripheral wound edges and is independent of flap type.
实验研究表明，在 7-8 天后，肌皮瓣即使没有主要蒂部也能存活，因为其血运重建来自周围营养良好的组织。然而，已有研究报道在切断蒂部后肌皮瓣的肌肉成分会丢失。在皮瓣中，没有研究通过阻断周围皮肤床来检查来自下方床的血管生长的性质。因此，本研究旨在通过阻断边缘和受区的新血管化来研究皮瓣和带皮肤肌肉瓣在阻断主要血管供应后主要血管来源的新血管化的来源。
将 28 只大鼠分为四组。在第 I 组中，皮瓣掀起一个最大的皮瓣（MCIF），并用硅酮片封闭皮瓣的边缘。在第 II 组中，掀起一个 MCIF，并用硅酮片封闭受区。在第 III 组中，掀起一个最大的皮瓣作为带全厚皮片（FTSG）的岛状皮瓣，并在边缘用硅酮片封闭。在第 IV 组中，掀起一个带 FTSG 的岛状皮瓣作为岛状皮瓣，并在受区用硅酮片封闭。在术后第 7 天，对每个动物进行血管结扎。首次手术后 14 天进行血管造影研究和组织病理学评估。
在血管造影研究中，第 II 组和第 IV 组（受区被阻断的组）的新生血管化比第 I 组和第 III 组（边缘被阻断的组）更为明显。组织病理学检查发现，第 I 组和第 III 组的血管数量明显低于第 II 组和第 IV 组（p<0.001）。
我们的研究结果表明，在肌皮瓣中，来自受区或边缘的新生血管化足以确保皮瓣完全存活，在大鼠中，皮瓣抬高 7 天后，如果受区或边缘有良好的血管化，带皮肤的肌肉瓣不需要主要的轴状血管。研究结果还表明，再血管化主要来自周围的边缘，与皮瓣类型无关。
