A Systematic Study of Vascular Distribution Characteristics and Axis Design of Various Flap Types

Abstract

BackgroundThe aim of this study was to define blood flow characteristics of multiple types of flaps and the theoretical basis of flap axis design.Material/MethodsSixty Sprague-Dawley (SD) rats were randomly divided into 6 groups: a normal skin group, and 5 groups with different types of flap: abdominal flap group, dorsal flap group, single-perforator flap group, double-perforators flap group, and delayed cutaneous nerve flap group. The vascular distribution characteristics of normal skin and various flap types were observed by gross morphology of specimens and X-ray after perfusion.ResultsThere were distinct differences in vascular anastomosis and density in dorsal and ventral SD rats. The area of flap survival in the dorsal flap group was superior to that in the abdominal flap group, but the flap axis of the 2 groups passed straight through the middle of the pedicle. The flap surviving area in the double-perforators flap group was remarkably larger than in the single-perforator flap group, while the flap axis in the single-perforator flap group passed straight through the perforators, and in the double-perforators flap group there was a linking vessel between the 2 perforators. There were linking and reticulate vessels, in addition, linking vessels and cutaneous nerves were concomitant in the delayed cutaneous nerve flap group. The flap axis was the travel route of the cutaneous nerve.ConclusionsVariations in flap blood supply patterns and axes with alterations based on flap types have implications for flap survival. Understanding blood flow characteristics within each flap type and accurately designing the flap axis is essential for flap survival.

Roxadustat promotes hypoxia‐inducible factor‐1α/vascular endothelial growth factor signalling to enhance random skin flap survival in rats

“…The optimal flap ratio is 1.5 to 2:1 to ensure blood perfusion in a distal flap. 8 The onset of oxidative stress and inflammation caused by ischaemia/reperfusion (I/R) after flap transplantation can drastically damage flap cells, leading to vascular injury and an increased risk of skin flap necrosis. 5 Hence, promoting angiogenesis and improving the local blood supply, while reducing complications, play a vital role in enhancing the survival of random skin flaps.…”

Berberine promotes the viability of random skin flaps via the PI3K/Akt/eNOS signaling pathway

“…It has no independent arteriovenous system, relying mainly on perfusion of the dermal vascular network; as much, necrosis frequently occurs at the distal flap due to an insufficient blood supply (Jafari et al, 2017; Lee et al, 2017). Therefore, the length: width ratio of the flap is limited to 1.5–2:1 (Deng et al, 2019). Despite continuous advances in surgical procedures and techniques, postoperative flap necrosis is still a common complication (Chen et al, 2018).…”

Rivastigmine Regulates the HIF-1α/VEGF Signaling Pathway to Induce Angiogenesis and Improves the Survival of Random Flaps in Rats

“…Based on their histological characteristics, random flaps have a maximum aspect ratio of 1.5-2:1. As the head and neck has relatively abundant microcirculation, the aspect ratio can be increased (Deng et al, 2019). At the same time, the skin flap survival area can also be increased by increasing blood perfusion and constructing a new capillary network.…”