Fichter Andreas M, Borgmann Anna, Ritschl Lucas M, Mitchell David A, Wagenpfeil Stefan, Dornseifer Ulf, Wolff Klaus-Dietrich, Mücke Thomas
Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich 81675, Germany.
Institute for Medical Biometriy, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg, Germany.
Br J Oral Maxillofac Surg. 2014 May;52(5):432-7. doi: 10.1016/j.bjoms.2014.02.013. Epub 2014 Mar 11.
Perforator flaps are becoming increasingly important in reconstructive microsurgery because of their reduced donor-site morbidity. However, one drawback is partial necrosis caused by vasospasm or inconsistency of delicate perforator vessels. In this study we have evaluated the number and capacity of perforator vessels with respect to the size of a flap, and the influence of vascular endothelial growth factor (VEGF) on the capacity of perforators in a standard animal model. We realised an epigastric perforator flap 4cm×7cm in 36 rats. In 3 control groups (n=6 in each), flaps were raised based on 4, 2, or 1 perforator vessel(s), while all other perforators as well as the epigastric vessels were ligated. In three study groups (n=6 in each), set up in the same way as the control groups, we also injected a single dose of VEGF into the wound area. After one week, all areas of necrosis were assessed planimetrically. We also evaluated the wounds by laser Doppler flowmetry preoperatively and after one week, and by histological and immunohistochemical examination. An increased number of perforators, together with VEGF, was associated with a significant reduction in the areas of necrosis. This observation was particularly true in flaps based on only one perforator. The inclusion of additional perforators has a more important role in the success of a flap than theoretical models suggest. Proangiogenetic factors may improve the viability of perforator flaps.
由于穿支皮瓣供区并发症减少，其在显微重建外科中正变得越来越重要。然而，一个缺点是由血管痉挛或精细穿支血管不一致导致的部分坏死。在本研究中，我们在标准动物模型中评估了穿支血管的数量和容量与皮瓣大小的关系，以及血管内皮生长因子（VEGF）对穿支血管容量的影响。我们在36只大鼠身上制作了4cm×7cm的腹壁穿支皮瓣。在3个对照组（每组n = 6）中，皮瓣基于4支、2支或1支穿支血管掀起，同时结扎所有其他穿支血管以及腹壁血管。在3个研究组（每组n = 6）中，以与对照组相同的方式设置，我们还在伤口区域注射了单剂量的VEGF。一周后，通过面积测量法评估所有坏死区域。我们还在术前和一周后通过激光多普勒血流仪评估伤口，并进行组织学和免疫组织化学检查。穿支数量增加以及VEGF与坏死面积的显著减少相关。这一观察结果在仅基于一支穿支的皮瓣中尤为明显。纳入额外的穿支在皮瓣成功中所起的作用比理论模型所表明的更为重要。促血管生成因子可能会提高穿支皮瓣的存活率。
