J Reconstr Microsurg 2016; 32(09): 683-687
DOI: 10.1055/s-0036-1585468
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preliminary Exploration: When Angiosome Meets Prefabricated Flaps

Heng Xu
1   Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Zheng Zhang
1   Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Yimeng Xia
2   Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Zvi Steinberger
3   Department of Orthopaedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
,
Peiru Min
1   Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Hua Li
1   Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Yahui Dai
4   Department of Orthopaedic, Tongji Hospital of Tongji University, Shanghai, China
,
Yixin Zhang
1   Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations
Further Information

Publication History

27 March 2016

01 June 2016

Publication Date:
25 July 2016 (online)

Abstract

Background The best known limitation to the use of prefabricated flaps is their limited survival area. One explanation for this is insufficient neovascularization. However, blood flow of prefabricated flaps is through their innate vascular network. This could lead one to conclude that angiosomes may impede blood perfusion. This study aims to settle this contradiction between theory and clinical practice.

Methods We performed a two-stage operation of a prefabricated abdominal flap in a rat model. The rats were divided into five groups (n = 6/group). Group A: fixed pedicle at a horizontal angle; Group B: fixed pedicle at an oblique angle; Group C: fixed pedicle at a vertical angle; Group D: fixed pedicle in the same position as Group A; and Group E: axial flap. Groups A and B were prefabricated for 2 weeks and Groups C and D were prefabricated for 3 weeks. Macroscopic appearance was noted, and analysis of near-infrared fluorescence imaging and capillary density was performed.

Results There was no significant difference in the flaps' survival area between Groups A and B. Group D had a significantly larger survival area when compared with Group C. The boundary between two angiosomes (medioventral line) seemed to limit the indocyanine green perfusion in Groups B, C, and E, while in Groups A and D, no such limitation was seen. Capillary density was positively correlated with neovascularization time.

Conclusions Angiosomes impede blood perfusion in prefabricated flaps. Cross-bound neovascular vessels nourish the flap, thus overcoming the limitation of choke vessels.

Note

Heng Xu and Zheng Zhang have contributed equally to the preparation of the work.


 
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