From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; the Department of Plastic and Reconstructive Surgery, Xiangya Changde Hospital; and the Division of Plastic Surgery, University of California, Davis.
Plast Reconstr Surg. 2021 May 1;147(5):1105-1115. doi: 10.1097/PRS.0000000000007893.
Vascular supercharge and flap prefabrication are two surgical maneuvers to improve flap blood supply. Although these techniques have been studied intensively, few studies have focused on the differences between supercharge and prefabricated flaps regarding their flap survival areas, vasculatures, and hemodynamics.
In this study, 21 male Sprague-Dawley rats were divided into three groups as follows: group A, single perforator flap; group B, supercharge flap; and group C, prefabricated flap. Flap survival was measured 1 week after flap elevation. Indocyanine green angiography was applied to visualize flap vascularity and to analyze flap hemodynamics. Von Willebrand factor immunohistochemical staining was applied to assess the number of microvessels in the choke zone of the abdominal wall.
The flap survival areas were expanded significantly in the arteriovenous supercharge group and the vascular bundle prefabricated group compared with that in the single-perforator group (81.34 ± 8.12 percent and 75.51 ± 8.08 percent versus 46.27 ± 10.01 percent, respectively; p < 0.05). Hemodynamic analysis suggested that although a significant increase in arterial infusion could be achieved with flap prefabrication, the venous effusion of the prefabricated flap was the worst among the three groups, indicating greater susceptibility to compromised venous return. Active neovascularization was confirmed by an increased number of microvessels in group C. Specifically, the dilatation of choke vessels and the newly formed vessels of the prefabricated pedicle could be appreciated by indocyanine green angiographic mapping.
Both vascular supercharge and flap prefabrication can augment the blood supply of the perforator flap but by means of different mechanisms. Because a supercharge flap is less susceptible to venous compromise, it is suggested to first consider the use of vascular supercharging when feasible.
血管增压和皮瓣预制是两种改善皮瓣血供的手术操作。尽管这些技术已经得到了深入研究，但很少有研究关注增压和预制皮瓣在皮瓣存活面积、血管和血液动力学方面的差异。
本研究将 21 只雄性 Sprague-Dawley 大鼠分为三组：A 组，单穿支皮瓣；B 组，血管增压皮瓣；C 组，预制皮瓣。皮瓣抬高 1 周后测量皮瓣存活面积。应用吲哚菁绿血管造影术显示皮瓣的血管分布，并分析皮瓣的血液动力学。应用血管性血友病因子免疫组化染色评估腹壁锁血管区微血管数量。
与单穿支组相比，动静脉增压组和血管束预制组的皮瓣存活面积显著增加（81.34 ± 8.12%和 75.51 ± 8.08%比 46.27 ± 10.01%，p < 0.05）。血液动力学分析表明，虽然预制皮瓣可以显著增加动脉灌注，但预制皮瓣的静脉回流最差，表明静脉回流受损的风险更大。C 组通过增加微血管数量证实了活跃的新生血管形成。具体而言，通过吲哚菁绿血管造影图可以观察到预制蒂部锁血管扩张和新生血管形成。
血管增压和皮瓣预制均可增加穿支皮瓣的血供，但机制不同。由于增压皮瓣对静脉阻塞的敏感性较低，因此建议在可行的情况下首先考虑使用血管增压。
