Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: Results from a rat model

Park, Seong Oh; Cho, Jeongmok; Imanishi, Nobuaki; Chang, Hak

doi:10.1016/j.bjps.2017.09.001

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…In addition, 3DCTA could not visualize fine vascular structures especially if the size of vascular structure is smaller than the section thickness. This can be prominent during small animal experiments 24 ( Fig. 5 ).…”

Section: Discussionmentioning

confidence: 77%

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

2022

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In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

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Section: Discussionmentioning

confidence: 77%

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

2022

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“…However, if the flap is nourished by only one perforator vessel, distal end necrosis can occur due to insufficient blood supply, oxidative stress, and cells apoptosis (Mohan, Zhu, Wang, Vijayasekaran, & Saint‐Cyr, 2016; Wang et al, 2019a; Wang et al, 2019b). Numerous measures have been developed to improve the survival of a flap with multiple vascular territories, such as transposition of a main vascular pedicle (Ding et al, 2017; Wang et al, 2019c), injection of angiogenic growth factors (Akimoto et al, 2013; Aksakal et al, 2016; Tao et al, 2016a), vascular delay (Lineaweaver et al, 2004; Mao et al, 2019; Seyhan, Deniz, Borman, Ulusal, & Cağlar, 2010), and use of venous superdrainage or arterial supercharging (Hallock & Rice, 2005; Park, Cho, Imanishi, & Chang, 2018; Mao et al, 2019; Xin, Luan, Mu, & Mu, 2013; Yi et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats

et al. 2020

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Background Arterial supercharging and venous superdrainage have been the commonly used vascular augmentation techniques for resolving partial loss of flaps in reconstructive surgery. It remains controversial which one of them is more effective in improving flap survival. The purpose of this study was to compare the effect of distal venous superdrainage and arterial supercharging on the survival of an extended dorsal perforator flap in rats. Materials and Methods Sixty Sprague–Dawley rats were randomly divided into three groups (n = 20 in each group). An extended dorsal perforator flap with the size of 3 × 12 cm based on the deep circumflex iliac artery and vein was elevated in each rat. In arterial supercharging group, the thoracodorsal artery was retained as the distal supercharging vessel; In venous superdrainage group, the thoracodorsal vein was retained as the distal superdrainage vessel. In control group, no other arteries and veins were retained except the main vascular pedicle. On the seventh day after operation, the survival area of flap was calculated as a percentage of viable area to the total flap. Vascular changes in the choke zones were assessed by angiography. Microvascular density and diameter were assessed via immunohistochemistry staining of CD31 on the fifth day after operation. Results The flap survival area in arterial supercharging group was significantly higher than that in venous superdrainage group (98.9 ± 0.8% vs. 81.5 ± 3.5%, p < .001). By gross observation, the extent of dilation of choke zone vessels in venous superdrainage group was smaller compared with that in arterial supercharging group. The density of CD31‐positive vessels and the diameter of choke zone vessels in arterial supercharging group were significantly larger than that in venous superdrainage group (23.4 ± 4.6 mm−2 vs. 13.1 ± 4.2 mm−2, p < .05; and 37.5 ± 5.8 μm vs. 27.8 ± 4.9 μm, p < .05). Conclusion Compared with venous superdrainage, distal arterial supercharging in the potential territory resulted in better survival of an extended dorsal perforator flap in a rat model.

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“…The anatomical territory survives easily as both its arterial blood supply and venous return do not need to pass through any choke vessels; the dynamic territory also survives relatively easily as the arterial blood supply and venous return only need to pass through one choke vessel; however, the potential territory has difficulties in surviving as its arterial blood supply and venous return are required to pass through 2 choke vessels 7 . Therefore, to promote the survival of the distal part of the multiterritory perforator flap, researchers have focused on reducing the number of choke vessels that the arterial blood supply and/or venous return of the distal part of the flap have to pass through, using techniques such as arterial supercharging, 8,9 venous superdrainage, 10,11 and changing the position of the venous drainage 12,13 . However, the premise of these studies was that all choke vessels offer the same degree of obstruction to the arterial blood supply or venous return.…”

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confidence: 99%

“…7 Therefore, to promote the survival of the distal part of the multiterritory perforator flap, researchers have focused on reducing the number of choke vessels that the arterial blood supply and/or venous return of the distal part of the flap have to pass through, using techniques such as arterial supercharging, 8,9 venous superdrainage, 10,11 and changing the position of the venous drainage. 12,13 However, the premise of these studies was that all choke vessels offer the same degree of obstruction to the arterial blood supply or venous return.…”

mentioning

confidence: 99%

The Effects of Angiosome Morphology on Choke Vessels and Flap Necrosis in a Rat Multiterritory Perforator Flap

Zhao

Kang

et al. 2023

Ann Plast Surg

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Background 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. Methods 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. Results 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. Conclusions The choke vessel adjacent to the craniocaudal and unidirectional TDAV significantly blocked venous return. Increasing venous return may reduce the necrosis.

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Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: Results from a rat model

Cited by 10 publications

References 22 publications

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats

The Effects of Angiosome Morphology on Choke Vessels and Flap Necrosis in a Rat Multiterritory Perforator Flap

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