Department of Hand and Plastic Surgery, Second Affiliated Hospital and Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China.
Br J Surg. 2015 Mar;102(4):375-81. doi: 10.1002/bjs.9732.
Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow-through blood supply, compared with that of a flap with a flow-end blood supply and perforator terminal branch.
Forty Sprague-Dawley rats, 20 in each group, were assigned to transfer of a superficial epigastric artery pedicle island flap with a flow-through or flow-end configuration of blood supply. Laser Doppler imaging was used to evaluate flap perfusion 2 h, 3 days and 5 days after surgery. The rats were killed on day 5, and lead oxide-gelatine-enhanced flap angiography and histology with haematoxylin and eosin staining was performed. Dorsal midline tissue was excised for quantification of vascular endothelial growth factor by western blot assay.
On day 5 after surgery, the flow-through group exhibited a significantly greater mean(s.d.) flap survival area (97·8(3·5) versus 80·8(10·2) per cent; P = 0·003), microvascular density (303(19) versus 207(41) per mm(2) ; P < 0·001) and perfusion (8·64(0·14) versus 5·95(0·14) perfusion units; P < 0·001) than the flow-end group. The flow-through group exhibited more angiosomes connected by dilated vascular anastomoses between the skin and subcutaneous fasciae.
The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.
皮瓣转移后的存活取决于筋膜下方动脉血供的血流。本研究评估了具有穿支侧支和直通血流供应的蒂皮瓣与具有血流终末供应和穿支终末分支的皮瓣的存活情况。
40 只 Sprague-Dawley 大鼠，每组 20 只，被分配到具有直通或血流终末配置的腹壁浅动脉蒂岛状皮瓣转移。激光多普勒成像用于评估手术后 2 小时、3 天和 5 天的皮瓣灌注。第 5 天处死大鼠，进行氧化铅-明胶增强皮瓣血管造影和苏木精-伊红染色的组织学检查，并通过 Western blot 测定血管内皮生长因子。
手术后第 5 天，直通组的皮瓣存活面积（97.8(3.5) 比 80.8(10.2) ；P=0.003）、微血管密度（303(19) 比 207(41) ；P<0.001）和灌注（8.64(0.14) 比 5.95(0.14) ；P<0.001）均显著大于血流终末组。直通组的皮瓣显示出更多的血管球，通过皮肤和皮下筋膜之间的扩张血管吻合连接。
直通血流供应改善了蒂穿支皮瓣的存活。手术相关性 穿支皮瓣失败主要是由于血供受损，因为血流终末构型仅由动脉的穿支终末分支滋养。本研究表明，由穿支侧支提供的直通血流供应改善了皮瓣的存活，增加了侧支血管吻合的扩张和新生血管形成。使用直通构型可提高穿支皮瓣的存活率，从而最大限度地减少皮瓣坏死引起的发病率。
