Erratum: Prefabricated Flaps: Identification of Microcirculation Structure and Supercharging Technique Improving Survival Area

Xu, Heng; Feng, Shaoqing; Xia, Yanfei; Steinberger, Zvi; Xi, Wenjing; Fang, Hongwei; Li, Zhiwei; Xie, Yixin; Zhang, Yixin

doi:10.1055/s-0036-1597896

Cited by 11 publications

(9 citation statements)

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“…In cases where more flap tissue is required, the flap might require supercharging or other manipulation of the flap microcirculation. 20,21 This present study has several limitations. First, this is a primary animal model, which does not fully reflect the human anatomy and physiology, and requires further large animal modeling or clinical exploration.…”

Section: Discussionmentioning

confidence: 85%

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Identification of Unequal Flow-Carrying Capabilities of Choke Vessels in Rat Abdominal Flaps

Zhu

Xiao

et al. 2022

Ann Plast Surg

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Background: Although the angiosome concept is a well-accepted theory, unexpected necrosis suggests that other factors can influence the flap survival. Our study uses the rat model to explore the flow capacity of the choke vessels across 2 angiosomes. Methods: The medioventral line of Sprague-Dawley rats' abdominal flap was equally divided into 4 sections, which were preserved in 7 different groups (n = 6/group): A, no dissection; B to D, preserve the inferior 1/4, 2/4, and 3/4 sections; E to G, preserve the superior 1/4, 2/4, and 3/4 sections. The ratio (%) of the survival area of the distal/ proximal territory was calculated. Indocyanine green, lead-oxide gel imaging, hematoxylin and eosin, and CD31 histology tests were performed. Results: Compared with 96.0 ± 1.4% flap survival in group A, groups B, C, and D had distal territory flap loss (34.8% ± 4.1%, 65.0% ± 3.7%, and 94.3% ± 3.1% respectively). Group E lost the majority of the distal territory (3.5% ± 2.4%), whereas groups F and G (15.5% ± 3.8% and 79.2% ± 3.3%, respectively) had larger flap survival. Except for groups A and D, each of the other 2 groups showed statistically significant results (P < 0.001). Indocyanine green indicated no blood flow at the superior 1/4 part. Lead-oxide gel and histology showed that the choke vessels residing along the medioventral line had no significant difference. Conclusions: Choke vessels do not carry blood flow equally. Two categories of choke vessels-"resting" and "active"-are proposed. The "active" form has variable flow carrying capabilities when the flap is harvested in different designs.

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Section: Discussionmentioning

confidence: 85%

“…Therefore, the “unequal flow carrying capabilities” logically makes sense and seems correct to prove this point. In cases where more flap tissue is required, the flap might require supercharging or other manipulation of the flap microcirculation 20,21 …”

Section: Discussionmentioning

confidence: 99%

Identification of Unequal Flow-Carrying Capabilities of Choke Vessels in Rat Abdominal Flaps

Zhu

Xiao

et al. 2022

Ann Plast Surg

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“…Many clinical and experimental studies show that arterial hypo-perfusion in the distal part of the flap leads to impaired venous drainage and venous congestion; therefore arteriovenous supercharging in the distal part of the flap should increase arterial blood supply, thus reducing flap necrosis. 15–17 In the sural flap, blood can flow from the SSV to concomitant veins accompanying the sural nerve and sural artery, thus passing blood from superficial to deep venous systems. 18…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous supercharging: A novel approach to improve reliability of the distally based sural flap

2021

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Complex soft-tissue defects of the distal third of the leg, foot and ankle with exposed bones/joints, tendons and implants need a flap for their closure. Distally based sural flap is commonly used, but it has a high partial necrosis rate due to venous insufficiency. We addressed this issue with AV supercharging by dorsalis pedis artery with short saphenous vein. Eight patients (seven males, mean age 34.12 years) with post traumatic lower limb defects over heel and foot were included. All flaps survived and healed although four flaps developed superficial partial epidermolysis. Average healing time was 20.12 days. Closure of the AV fistula was not required in any of the patients. At mean follow-up of two months, all patients were ambulatory with well settled flap. Arteriovenous supercharging of distally based sural flap through short saphenous vein improves the distal arterial perfusion in the flap and prevents distal flap necrosis.

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“…For example, the donor site of the posterior tibial artery flap might be the medial leg or the planta pedis; however, the axis was always the travel route of the posterior tibial artery, and a combined flap might be incised. In addition, the axis of a prefabricated flap belonging to axis-pattern flap was always the travel route of prefabricated vessels [27].…”

Section: Discussionmentioning

confidence: 99%

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

Deng

Wei

et al. 2019

Med Sci Monit

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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.

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Erratum: Prefabricated Flaps: Identification of Microcirculation Structure and Supercharging Technique Improving Survival Area

Cited by 11 publications

References 0 publications

Identification of Unequal Flow-Carrying Capabilities of Choke Vessels in Rat Abdominal Flaps

Identification of Unequal Flow-Carrying Capabilities of Choke Vessels in Rat Abdominal Flaps

Arteriovenous supercharging: A novel approach to improve reliability of the distally based sural flap

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

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