Perforator flaps-how many perforators are necessary to keep a flap alive?
Perforator flaps-how many perforators are necessary to keep a flap alive?
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DOI：
10.1016/j.bjoms.2014.02.013
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发表时间：
2014-05-01
影响因子：
1.8
通讯作者：
Muecke, Thomas
中科院分区：
文献类型：
--
作者：
Fichter, Andreas M.;Borgmann, Anna;Muecke, Thomas
穿支皮瓣在显微外科重建中越来越重要，因为它能减少供区的并发症。然而，一个缺点是由血管痉挛或脆弱的穿支血管的不一致引起的部分坏死。在这项研究中，我们已经评估了穿支血管的数量和容量相对于皮瓣的大小，和血管内皮生长因子（VEGF）的影响，在一个标准的动物模型中的穿支血管的能力。我们在36只大鼠中实现了4 cm x 7 cm的上腹部穿支皮瓣。在3个对照组（每组n = 6）中，根据4、2或1条穿支血管提起皮瓣，同时结扎所有其他穿支血管以及上腹部血管。在以与对照组相同的方式建立的三个研究组（每组n = 6）中，我们也将单剂量的VEGF注射到伤口区域。一周后，对所有坏死区域进行平面评估。我们还评估了手术前和一周后的激光多普勒血流仪，并通过组织学和免疫组织化学检查的伤口。交通支数量的增加，以及VEGF，与坏死面积的显着减少。这一观察结果在仅基于一个穿支的皮瓣中尤其正确。包含额外的穿支在皮瓣成功中的作用比理论模型所建议的更重要。促血管生成因子可提高穿支皮瓣的成活率。(C)2014年英国口腔颌面外科医师协会。由爱思唯尔有限公司出版。保留所有权利。
Perforator flaps are becoming increasingly important in reconstructive microsurgery because of their reduced donor-site morbidity. However, one drawback is partial necrosis caused by vasospasm or inconsistency of delicate perforator vessels. In this study we have evaluated the number and capacity of perforator vessels with respect to the size of a flap, and the influence of vascular endothelial growth factor (VEGF) on the capacity of perforators in a standard animal model. We realised an epigastric perforator flap 4 cm x 7 cm in 36 rats. In 3 control groups (n = 6 in each), flaps were raised based on 4, 2, or 1 perforator vessel(s), while all other perforators as well as the epigastric vessels were ligated. In three study groups (n = 6 in each), set up in the same way as the control groups, we also injected a single dose of VEGF into the wound area. After one week, all areas of necrosis were assessed planimetrically. We also evaluated the wounds by laser Doppler flowmetry preoperatively and after one week, and by histological and immunohistochemical examination. An increased number of perforators, together with VEGF, was associated with a significant reduction in the areas of necrosis. This observation was particularly true in flaps based on only one perforator. The inclusion of additional perforators has a more important role in the success of a flap than theoretical models suggest. Proangiogenetic factors may improve the viability of perforator flaps. (C) 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.