Taylor G Ian, Corlett Russell J, Ashton Mark W
Parkville, Victoria, Australia.
From the Taylor Lab, Department of Anatomy and Neuroscience, and the Royal Melbourne Hospital Department of Surgery, University of Melbourne.
Plast Reconstr Surg. 2017 Oct;140(4):721-733. doi: 10.1097/PRS.0000000000003694.
The angiosome is a three-dimensional block of tissue supplied by a source vessel with its boundary outlined either by an anastomotic perimeter of reduced-caliber choke vessels or by true anastomoses with no reduction of vessel caliber. This article focuses on the role of these anastomotic vessels in defining flap survival or the necrotic pattern seen in fulminating meningococcal septicemia.
Experiments in pigs, dogs, guinea pigs, and rabbits over the past 46 years were reviewed, focusing on the necrosis line of flaps, the effects of various toxins in vivo, and correlating these results in the clinical setting.
Experimentally, choke anastomoses are functional and control flow between perforator angiosomes. They (1) permit capture of an adjacent angiosome when the flap is raised on a cutaneous perforator in 100 percent of cases, with the necrosis line occurring usually in the next interperforator connection; (2) confine flow to the territory of the involved artery when a toxin is introduced by spasm around its perimeter; and (3) lose this property of spasm when choke vessels are converted to true anastomoses following surgical delay, or where true anastomoses occur naturally, thereby allowing unimpeded blood flow and capture of additional angiosome territories. Clinical experience supports these observations.
The functional angiosome is the volume of tissue that clinically can be isolated on a source vessel. The area extends beyond its anatomical territory to capture an adjacent territory if connections are by choke anastomoses, or more if they are by true anastomoses.
血管体是由一条源血管供血的三维组织块，其边界由口径缩小的阻塞血管的吻合周边界定，或由血管口径无缩小的真性吻合界定。本文重点探讨这些吻合血管在确定皮瓣存活或暴发性脑膜炎球菌败血症中所见坏死模式方面的作用。
回顾了过去46年在猪、狗、豚鼠和兔子身上进行的实验，重点关注皮瓣的坏死线、各种毒素在体内的作用，并将这些结果与临床情况相关联。
在实验中，阻塞性吻合是功能性的，可控制穿支血管体之间的血流。它们（1）在100%的病例中，当皮瓣在皮肤穿支上掀起时，允许捕获相邻的血管体，坏死线通常发生在下一个穿支间连接部位；（2）当毒素通过其周边痉挛引入时，将血流限制在所涉及动脉的区域内；（3）当阻塞血管在手术延迟后转变为真性吻合，或在自然发生真性吻合的情况下，失去这种痉挛特性，从而允许血流不受阻碍，并捕获额外的血管体区域。临床经验支持这些观察结果。
功能性血管体是临床上可在一条源血管上分离的组织体积。如果连接是通过阻塞性吻合，该区域会延伸至其解剖区域之外以捕获相邻区域；如果是通过真性吻合，则延伸得更多。
