The experimental study of shunt-decompression arterialized vein flap

Abstract

BackgroundArterialized vein flap is a kind of unphysiological flap. Unphysiological reconstruction of blood circulation leads to higher load than that supported by physiological flap and is the culprit of flap swelling, blood stasis, skin blistering, and necrosis after flap grafting. To resolve the multiple disadvantages of traditional flap grafting, by introducing the principles of fluid mechanics, shunt-decompression surgery is prepared to decline the circulation preload and improve the prognosis of arterialized vein flap grafting.MethodsBy introducing the principles of fluid mechanics, we established the model of shunt-decompression arterialized vein flap, which satisfied the common properties of general fluid that the interface pressure between object and fluid is reduced when the velocity of fluid is increased and vice versa—the effect of Bernoulli. Under this rule, we anastomose the arterialized vein to the branch of main artery of recipient region or make end-to-side anastomosis, which can maintain the blood flow of main artery, decrease the perfusion of flap, and preserve the decompressive effect of main artery to branches. From March, 2016 to September, 2016, we performed animal experiments on ten male bama mini pigs with average weight of 28 ± 2.35 kg. Superior epigastric artery of pig was used for feeding artery to arterialize the superficial epigastric veins. The total area of flap is 8 cm × 6 cm. End-to-side anastomosis and end-to-end anastomosis were established in experimental group and control group, respectively. Doppler speckle perfusion imaging apparatus was used to monitor the alterations of flap perfusion, blood flow of flap, tissue swelling and survival of flaps.ResultsThe average flap perfusion (PU) at 1 week after surgery is 83.62 ± 3.14 in experimental group and 98.14 ± 6.54 in control group, respectively (P < 0.05), indicating the significant reduction of flap blood perfusion in experimental group as compared with control group. As to the survival of flaps, 7 flaps completely survived, 3 showed partial necrosis, and no one was found as complete necrosis in experimental group, while only 3 flaps survived, and 4 flaps and 3 flaps showed partial necrosis and complete necrosis in control group, respectively (P < 0.05).ConclusionBased on the physiological features of arterialized vein flap and its problems in clinical application, we improved the anastomosis strategy of flap grafting and obtained excellent experimental outcomes, which provides an insight for the clinical application of arterialized vein flaps.Electronic supplementary materialThe online version of this article (10.1186/s12935-018-0622-z) contains supplementary material, which is available to authorized users.

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

“…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…”

“…Thus, we achieved reduced arterial flow to the sural flap by a shunt-decompression mechanism based on the principle of Bernoulli fluid mechanics. 16 Such a flap is halfway between a free and a pedicle flap and can be used when free flaps are not feasible for logistic or technical reasons. It has an additional advantage of requiring only one anastomosis and a larger flap becomes available with extra dissection of the lesser saphenous vein.…”