Gascoigne Adam C, Taylor G Ian, Corlett Russell J, Briggs Chris, Ashton Mark W
Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Victoria, Australia.
Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Victoria, Australia.
Plast Reconstr Surg Glob Open. 2020 Jun 24;8(6):e2857. doi: 10.1097/GOX.0000000000002857. eCollection 2020 Jun.
It has been proposed that hyperperfusion of perforators and distension of anastomotic vessels may be a mechanism by which large perforator flaps are perfused. This study investigates whether increasing perfusion pressure of radiographic contrast in cadaveric studies altered the radiographic appearance of vessels, particularly by distending their anastomotic connections.
From 10 fresh cadavers, bilateral upper limbs above the elbow were removed. Three cadavers were excluded. Seven pairs of limbs were injected with lead oxide solutions via the brachial artery while distally monitoring intravascular pressure in the radial artery using a pressure transducer. One limb was injected slowly (0.5 mL/s) and the other rapidly (1.5 mL/s) to produce low and high perfusion pressures, respectively. Skin and subcutaneous tissue were then removed and radiographed.
The filling of perforators and their larger caliber branches appeared unchanged between low- and high-pressure injections, with ( = 0.32) and ( = 0.94) ( = 0.10). However, high-pressure injections revealed arteriovenous shunting with filling of the tributaries of the major veins.
This study demonstrated that increased perfusion pressure of the cutaneous arteries (1) did not change the caliber of vessels; (2) did not convert choke to true anastomoses; and (3) revealed arteriovenous shunting between major vessels with retrograde filling of venous tributaries as pressure increased. This suggests that it is not possible to distend anastomotic connections between vascular territories by increasing perfusion alone.
有人提出，穿支血管的高灌注和吻合血管的扩张可能是大型穿支皮瓣获得血供的一种机制。本研究调查在尸体研究中增加造影剂的灌注压力是否会改变血管的影像学表现，特别是通过扩张其吻合连接。
从10具新鲜尸体上取下双侧肘部以上的上肢。排除3具尸体。通过肱动脉向7对上肢注射氧化铅溶液，同时使用压力传感器在桡动脉远端监测血管内压力。一侧上肢缓慢注射（0.5毫升/秒），另一侧快速注射（1.5毫升/秒），分别产生低灌注压力和高灌注压力。然后去除皮肤和皮下组织并进行放射照相。
在低压和高压注射之间，穿支及其较大口径分支的充盈情况似乎没有变化， （ = 0.32）和 （ = 0.94） （ = 0.10）。然而，高压注射显示存在动静脉分流，主要静脉的支流有充盈。
本研究表明，皮肤动脉灌注压力增加（1）不会改变血管口径；（2）不会将阻断血管转变为真正的吻合血管；（3）随着压力增加，显示主要血管之间存在动静脉分流，静脉支流逆行充盈。这表明仅通过增加灌注不可能扩张血管区域之间的吻合连接。
