From the Department of Human Anatomy, Health Science Center, Yangtze University.
Department of Laboratory Medicine, Jingzhou Chest Hospital, Jingzhou.
Ann Plast Surg. 2023 Oct 1;91(4):479-484. doi: 10.1097/SAP.0000000000003643. Epub 2023 Aug 12.
Although the angiosome concept has been proposed for a long time, very few studies have been done on its morphology. Our study investigated the effects of angiosome morphology on choke vessels and flap necrosis in a rat multiterritory perforator flap.
Seventy-two male Sprague-Dawley rats were randomly divided into 3 groups (n = 24/group). The flap contained the right iliolumbar, posterior intercostal, and thoracodorsal angiosomes (TDAVs), termed angiosomes I, II, and III, respectively. Only the posterior intercostal artery and iliolumbar vein were preserved in group 1, whereas only the posterior intercostal artery and vein were preserved in group 2, and only the posterior intercostal artery and thoracodorsal vein were preserved in group 3. Distances from angiosome II to angiosome I (II-I), angiosome II to angiosome III (II-III), angiosome I to the caudal side of the flap (I-caudal), and angiosome III to the cranial side of the flap (III-cranial) were measured. Arteriography, flap necrosis, average microvascular density, and vascular endothelial growth factor expression were evaluated.
The II-I distance was significantly greater than that of II-III (3.853 ± 0.488 versus 3.274 ± 0.433 cm, P = 0.012), whereas the distance of I-caudal resembled that of III-cranial (1.062 ± 0.237 versus 0.979 ± 0.236 cm, P = 0.442). The iliolumbar and posterior intercostal angiosomes were multidirectional, whereas the TDAV was craniocaudal and unidirectional. Seven days after the operation, the choke arteries had transformed into true anastomotic arteries. Flap necrosis was lowest in group 3, followed by group 2, and highest in group 1 (10.5% ± 2.4% versus 18.3% ± 3.5% versus 25.5% ± 4.6%, P < 0.01), whereas group 3 showed the highest microvascular density and vascular endothelial growth factor expression, in contrast to groups 2 and 1, with the lowest.
The choke vessel adjacent to the craniocaudal and unidirectional TDAV significantly blocked venous return. Increasing venous return may reduce the necrosis.
尽管血管体概念已经提出很长时间了，但对其形态学的研究却很少。我们的研究调查了血管体形态对大鼠多区域穿支皮瓣的阻塞血管和皮瓣坏死的影响。
72 只雄性 Sprague-Dawley 大鼠随机分为 3 组（每组 n = 24）。皮瓣包含右髂腰、后肋间和胸背血管体（TDAVs），分别称为血管体 I、II 和 III。第 1 组仅保留后肋间动脉和髂腰静脉，第 2 组仅保留后肋间动脉和静脉，第 3 组仅保留后肋间动脉和胸背静脉。测量血管体 II 到血管体 I（II-I）、血管体 II 到血管体 III（II-III）、血管体 I 到皮瓣尾部（I-尾部）和血管体 III 到皮瓣头部（III-头部）的距离。评估血管造影、皮瓣坏死、平均微血管密度和血管内皮生长因子表达。
II-I 距离明显大于 II-III（3.853 ± 0.488 与 3.274 ± 0.433 cm，P = 0.012），而 I-尾部与 III-头部相似（1.062 ± 0.237 与 0.979 ± 0.236 cm，P = 0.442）。髂腰和后肋间血管体是多方向的，而 TDAV 是前后向的和单向的。术后 7 天，阻塞血管已转化为真正的吻合动脉。皮瓣坏死率最低的是第 3 组，其次是第 2 组，最高的是第 1 组（10.5% ± 2.4% 比 18.3% ± 3.5% 比 25.5% ± 4.6%，P < 0.01），而第 3 组的微血管密度和血管内皮生长因子表达最高，与第 2 组和第 1 组相比，第 3 组的最低。
邻近前后向单向 TDAV 的阻塞血管明显阻断静脉回流。增加静脉回流可能会减少坏死。
