The authors describe a study in which groin flaps from 20 Wistar rats were transplanted to another group of 20 Wistar rats and, after various time intervals, the groin flaps were re-transplanted back to the original animals. The goal of the first transfers was to preserve the flap in the second group of animals (isopreservation). During the isopreservation period, the second rat (the preserver) was treated with steroids or FK506 for immunosuppression. Thirty-three free groin flap transfers were performed between 40 rats. If possible, the same flap was transferred twice between two animals, one as an isograft, and other as an autograft following an isopreservation period in 13 pairs of animals. (A second transfer was not possible in seven pairs of animals.) The period for isopreservation varied between 2 days and 1 week. The survival of the flap was observed by visual inspection, laser Doppler flowmeter measurements, and was correlated with serial histopathologic examinations of skin and vessel biopsy specimens, including the anastomosis site. The severity of histopathologic signs that might be related to developing rejection was increased by the preservation time, and was more noticeable after the second transfer. The authors showed that successful secondary transplantation of the rat groin flap with a 1-week follow-up could be achieved, following isopreservation of at least up to 5 days.
Purpose: Haemangiomas and vascular malformations are not easy to differentiate clinically. We describe a patient who was initially thought to have a scrotal venous malformation (VM) but after pathological examination was diagnosed to be afflicted with an arteriovenous malformation (AVM) with a micro-fistula in pathorogical photo. We think that even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated. Material and Method: A 38-year-old man who noticed a mass in his scrotum. The patient was seen at our hospital in May 2009 with concern for progression of the scrotal mass. That mass appeared to indicate a simple case of VM of the scrotum. Result and Conclusion: A biopsy of the mass was performed and was diagnosed to be a micro-fistula AVM, with no tumour growth in the vascular endothelial cells. Resection was performed in September 2009. And there is no recurrence. Even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated.
An experimental study was done in rats in which the animals were randomly divided into four groups. Each group included bilateral standard island groin flaps. The right side flap was used as control. On the left side, after elevation of the flap, different types of arteriovenous connections were constructed distal to the pedicle between the femoral artery and vein. The connection type was a type-C (end-to-end) anastomosis in Group 1; a type-X (side-to-side) anastomosis in Group 2; a type-T a (artery-end-to-vein-side) anastomosis in Group 3; and a type-Tv (vein-end-to-artery-side) anastomosis in Group 4. Flow values in the flaps were measured externally and repeatedly using a laser Doppler flowmeter. Extremity changes, signs of congestive heart failure, flap weights (measured at the end of the study), thrombosis at the anastomosis or distal to it, edema in the flaps, subcutaneous venous stasis, and aneurysm formation in the anastomoses were observed. Histopathologic evaluations were also done. Only the side-to-side anastomosis group showed any aneurysm formation in the distal vein, as well as extremity changes and signs of congestive heart failure in some of the animals. Only the artery-end-to-vein-side group showed distal thromboembolism in some animals. All flaps survived, but there was prominent edema in the flaps of Group 2 and Group 4 animals in decreasing order. All the study flaps demonstrated subcutaneous venous stasis and capsule formation. The authors concluded that although any arteriovenous communication located distal to the pedicle of an island skin flap that connects the arterial to the venous system, bypassing microcirculation, may have some beneficial effects, it is not devoid of some possibly hazardous developments, including edema formation and venous stasis.
The importance of the location of a surgically-created arteriovenous fistula around the pedicle (both distal and proximal) on the viability of rat skin flaps was investigated. The animals were randomly divided into four groups. Group 1 included bilateral standard island groin flaps. The right side flap was used as a control. On the left side, after elevation of the flap, an X-type arteriovenous fistula greater than 1 mm (up to 2 mm) in length was created distal to the pedicle, and just before the bifurcation of the common femoral vessels. In Group 2, the flap was an axial-pattern medially-based peninsular flap, including the same vessels. In this group also, two flaps were elevated bilaterally, and the right side was used as a control; on the left side, an X-type arteriovenous fistula the same length as in Group 1 was also created distal to the pedicle. In both groups, all other branches of the common femoral vessels were kept intact. In a second part of the study, two other animal groups were used to clarify the importance of the length of the arteriovenous fistula on the viability of skin flaps. In Group 3, the model was the same as in Group 1, but the fistula was 1 mm in length. In Group 4, the length of the fistula was 1 mm, and its location was on the common femoral vessels proximal to the pedicle, using the same flap model. Flow values were measured repeatedly using a laser Doppler flowmeter. Histopathologic studies were also done. There are three important points arising from these studies. 1). The location of an X-type arteriovenous fistula around an island skin flap pedicle seems to be more important than diameter. An arteriovenous fistula proximal to the pedicle is more hazardous than an arteriovenous fistula distal to the pedicle, regarding island skin-flap viability. 2). However, the length of the fistula is also important, and an arteriovenous fistula distal to the pedicle, with a sufficiently long length, is not devoid of harmful effects. It is also clear that the larger the fistula, the greater the systemic effects. 3). An island skin flap with an arteriovenous fistula distal to its pedicle might be a useful model to study the relationship between skin-flap viability and edema formation.
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