Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Orthopaedic Surgery, Sheba Medical Center, Tel Hashomer, Israel.
J Reconstr Microsurg. 2019 Oct;35(8):568-574. doi: 10.1055/s-0039-1688752. Epub 2019 May 10.
Limited survival area is an intractable problem in the clinical practice of prefabricated flaps. This study compared four strategies to find an effective method and to understand the potential mechanisms for supercharging.
A prefabricated abdominal flap rodent model was prepared. Rats were randomly divided into five groups ( = 6/group). (A) Control group: prefabricated right side femoral vessels. Based on group A, various prefabricated vessels were added; (B) proximal venous supercharging group: right side superficial inferior epigastric vein (SIEV); (C) proximal arterial supercharging group: right side superficial inferior epigastric artery (SIEA); (D) distal venous supercharging group: left side SIEV; and (E) distal arterial supercharging group: left side SIEA. Macroscopic analysis, near-infrared fluorescence imaging, and microscopy were used to analyze the survival area, fluorescence area, and capillary density.
No significant differences in survival areas were found among supercharging groups (B-E), which were larger than in the control group. Near-infrared fluorescence imaging showed the areas of control and venous supercharging groups (A, B, and D) were smaller than in arterial groups (C and E). Capillary density areas in the right part of the flap in proximal supercharging groups (B and C) and left part of the flap in distal supercharging groups (D and E) were all greater than group A, with no significant differences among the other groups.
Enhanced neovascularization is a useful supercharging strategy. Both arterial and venous vessel supercharging improved the survival area of prefabricated flaps.
预制皮瓣的临床实践中存在有限的存活面积问题。本研究比较了四种策略,以寻找一种有效的方法,并了解增强的潜在机制。
制备预制腹壁皮瓣啮齿动物模型。大鼠随机分为五组(每组 n=6)。(A)对照组:预制右侧股血管。基于组 A,加入各种预制血管;(B)近端静脉增强组:右侧腹壁浅静脉(SIEV);(C)近端动脉增强组:右侧腹壁浅动脉(SIEA);(D)远端静脉增强组:左侧 SIEV;和(E)远端动脉增强组:左侧 SIEA。使用宏观分析、近红外荧光成像和显微镜分析存活面积、荧光面积和毛细血管密度。
增强组(B-E)的存活面积与对照组无显著差异,且大于对照组。近红外荧光成像显示,对照组和静脉增强组(A、B 和 D)的面积小于动脉组(C 和 E)。在近端增强组(B 和 C)的皮瓣右侧和远端增强组(D 和 E)的皮瓣左侧的毛细血管密度区域均大于 A 组,其他组之间无显著差异。
增强新生血管是一种有用的增强策略。动脉和静脉血管增强均改善了预制皮瓣的存活面积。