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Ji J, Chen D, Ni J, Chang F. Research Advances in Vascular Remodeling in Choke Vessels of Perforator Flap: A Systematic Review. Ann Plast Surg 2024; 93:268-275. [PMID: 38775375 DOI: 10.1097/sap.0000000000003980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND As a significant bridge between perforasomes, choke vessels are the key structure of blood supply expansion, also a prerequisite for preventing distal ischemic necrosis of the multiterritory perforator flap, where the remodeling of choke vessels after flap elevation plays an essential role. This systematic review highlights the underlying mechanisms and clinical ways to promote remodeling of choke vessels, as well as experimental observation approaches to further guide researchers. METHODS A systematic review was conducted from 1975 to 2023 through PubMed, EMBASE, Web of Science, and Cochrane database with the key words "choke vessels" and "perforator flap" to investigate the mechanisms and ways to promote remodeling of choke vessels as well as observation approaches. The inclusion criteria and exclusion criteria were set to screen the literature. RESULTS A total of 94 literatures were obtained through database retrieval. After removing the duplicate literature, reading the title and abstract, and reviewing the full text finally, 33 articles were included in the final study. CONCLUSIONS The underlying remodeling of choke vessels may be related to fluid shear stress, hypoxia, and inflammation. The clinical ways to promote remodeling of choke vessels include surgical delay, arterial supercharge, venous superdrainage, drugs, and stem cells. Various experimental methods of observing microvascular morphology allow for a comprehensive research of choke vessels.
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Affiliation(s)
- Jiahao Ji
- From the Department of Plastic and Burns Surgery, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
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Chen C, Li X, Hu Y, Chen Y, Wang H, Li X, Li X. Electrical stimulation promoting the angiogenesis in diabetic rat perforator flap through attenuating oxidative stress-mediated inflammation and apoptosis. PeerJ 2024; 12:e16856. [PMID: 38313008 PMCID: PMC10838069 DOI: 10.7717/peerj.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background Skin flap transplantation is one of the effective methods to treat the diabetes-related foot ulceration, but the intrinsic damage to vessels in diabetes mellitus (DM) leads to the necrosis of skin flaps. Therefore, the discovery of a non-invasive and effective approach for promoting the survival of flaps is of the utmost importance. Electrical stimulation (ES) promotes angiogenesis and increases the proliferation, migration, and elongation of endothelial cells, thus being a potential effective method to improve flap survival. Objective The purpose of this study was to elucidate the mechanism used by ES to effectively restore the impaired function of endothelial cells caused by diabetes. Methods A total of 79 adult male Sprague-Dawley rats were used in this study. Gene and protein expression was assessed by PCR and western blotting, respectively. Immunohistochemistry and hematoxylin-eosin staining were performed to evaluate the morphology and density of the microvessels in the flap. Results The optimal duration for preconditioning the flap with ES was 7 days. The flap survival area percentage and microvessels density in the DMES group were markedly increased compared to the DM group. VEGF, MMP2, and MMP9 protein expression was significantly upregulated. ROS intensity was significantly decreased and GSH concentration was increased. The expression of IL-1β, MCP‑1, cleaved caspase-3, and Bax were downregulated in the DMES group, while TGF-β expression was upregulated. Conclusions ES improves the angiogenesis in diabetic ischemic skin flaps by attenuating oxidative stress-mediated inflammation and apoptosis, eventually increasing their viability.
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Affiliation(s)
- Cong Chen
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaolu Li
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yong Hu
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yuan Chen
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Hongrui Wang
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xian Li
- Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xiucun Li
- Second Hospital of Shandong University, Jinan, Shandong, China
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Xi S, Zhao J, Kang R, Wang X, Zhang Q, Jin P, Cheng S. The Effects of Angiosome Morphology on Choke Vessels and Flap Necrosis in a Rat Multiterritory Perforator Flap. Ann Plast Surg 2023; 91:479-484. [PMID: 37553889 DOI: 10.1097/sap.0000000000003643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
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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Affiliation(s)
- Shanshan Xi
- From the Department of Human Anatomy, Health Science Center, Yangtze University
| | - Jingfeng Zhao
- From the Department of Human Anatomy, Health Science Center, Yangtze University
| | - Ruochen Kang
- From the Department of Human Anatomy, Health Science Center, Yangtze University
| | - Xinyue Wang
- From the Department of Human Anatomy, Health Science Center, Yangtze University
| | - Qingling Zhang
- Department of Laboratory Medicine, Jingzhou Chest Hospital, Jingzhou
| | | | - Sheng Cheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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'Supercharged' ALT Free flap resilience following total laryngopharyngectomy reconstruction. Br J Oral Maxillofac Surg 2023; 61:118-119. [PMID: 36593131 DOI: 10.1016/j.bjoms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
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Zhang W, Zhu W, Li X, Li X, Li X. Effects of Distal Arterial Supercharging and Distal Venous Superdrainage on the Survival of Multiterritory Perforator Flaps in Rats. J INVEST SURG 2022; 35:1462-1471. [PMID: 35414343 DOI: 10.1080/08941939.2022.2063459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Which one of the two measures, distal arterial supercharging (DAS) and distal venous superdrainage (DVS), is better to enhance flap survival? No consistent conclusions have been reached. METHODS All flaps were pedicled on the deep circumflex iliac vessels. Seventy-two healthy male rats were distributed to four groups randomly: DAVS group (distal arteriovenous supercharging group), the thoracodorsal (TD) artery and TD vein were preserved; DAS group (distal arterial supercharging group), the TD vein was ligated; DVS group (distal venous superdrainage group), the TD artery was ligated; control group, the TD artery and TD vein were ligated. Flap survival rate was evaluated on postoperative day 7. Flap angiography was performed to assess vascular changes of the flap. Microvascular density (MVD) was evaluated by hematoxylin and eosin staining, and CD34-positive microvessel density was measured by immunohistochemistry. Vascular endothelial growth factor (VEGF) level was measured by western blot. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were evaluated using specialized commercial kits. RESULTS The mean flap survival rate was increased significantly in DAVS and DAS groups than in DVS and control groups. DAVS and DAS groups had higher flap vascularization, MVD, CD34-positive microvessel density, VEGF expression and SOD level compared to DVS and control groups. DAVS and DAS groups also had lower MDA level relative to DVS and control groups. CONCLUSION DAS is more conducive to improving the survival rate of the multiterritory perforator flap compared to DVS, mainly by enhancing angiogenesis and preventing ischemia-reperfusion (I/R) injury.
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenjing Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Cheng S, Fu Y, Wan B, Yin S, Jin P, Xi S, Gao W. Which one is better for multi-territory perforator flap survival, central perforator artery or central perforator vein? J Plast Reconstr Aesthet Surg 2022; 75:2474-2481. [PMID: 35459635 DOI: 10.1016/j.bjps.2022.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The survival of multi-territory perforator flap is associated with the position of the perforators. This study aimed to explore whether use of the central perforator artery or vein was better for flap survival. METHODS 75 male Sprague-Dawley rats were randomly divided into three groups (n=25 per group). The flap contained the right and left iliolumbar, left posterior intercostal, and left thoracodorsal angiosomes, termed angiosomes Ⅰ to Ⅳ, respectively. The anastomosis between angiosomes Ⅱ and Ⅲ was termed choke 2. In experimental group 2, only the right iliolumbar vein and the left iliolumbar artery were preserved; in experimental group 1, only the right iliolumbar artery and the left iliolumbar vein were preserved; and in the control group, only the right iliolumbar artery and vein were preserved. On day-7 after the operation, the flap arteriography, intraluminal diameter, average microvascular density, vascular endothelial growth factor (VEGF) expression and flap survival were compared among groups. Moreover, the percentages of the angiosomes were measured. RESULTS The dilation of the choke 2 artery was most pronounced in experimental group 2, followed by experimental group 1, and, finally, the control group (p<0.05). Similar results regarding average microvascular density, VEGF expression, and survival rate were found among the three groups. The percentages of angiosomes Ⅰ to Ⅳ were 23.1%, 23.0±3.1%, 23.0±1.9%, and 31.0±3.1%, respectively. CONCLUSIONS Compared with the central perforator vein, the central perforator artery was more beneficial in enhancing flap survival. A multi-territory perforator flap with the central perforator artery could capture 3 angiosomes safely.
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Affiliation(s)
- Sheng Cheng
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China; Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Yu Fu
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou 434023, People's Republic of China
| | - Bing Wan
- Department of Imaging, Jingzhou Central Hospital, Jingzhou 434020, People's Republic of China
| | - Siyuan Yin
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou 434023, People's Republic of China
| | - Pan Jin
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou 434023, People's Republic of China
| | - Shanshan Xi
- Department of Human Anatomy, Yangtze University School of Medicine, Jingzhou 434023, People's Republic of China.
| | - Weiyang Gao
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China; Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, Zhejiang 325000, People's Republic of China.
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Different Transfer Forms of the Expanded Forehead Flap Pedicled with Superficial Temporal Vessels to Treat Chin and Submental Scar Deformities. J Craniofac Surg 2021; 33:1066-1070. [PMID: 34882651 DOI: 10.1097/scs.0000000000008412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The chin and submental regions are located at the junction of the face and neck. Its function and aesthetic appearance can be seriously affected when scar deformities cause the cervicomental angle to disappear. The expanded forehead flap pedicled with superficial temporal vessel(s) is a surgical treatment for chin and submental scar deformities. Different transfer types have developed for this flap based on individual situations. At present, there is no unified treatment strategy for applying this forehead flap to treat different regions and ranges of chin and submental scar deformities. METHODS Ninety one cases were collected from patients with chin and submental scar deformities that were treated using the expanded forehead flap pedicled with superficial temporal vessels from January 2008 to December 2018. The authors divided the chin and submental scar deformities into 4 types according to different regions and ranges, and summarized flap survival and complications of 5 different transfer forms used to treat scars for creating feasible treatment strategies. We followed up 76 cases, investigating the satisfaction of appearance and texture of the flaps, improvement of neck movement, and scar recurrence. RESULTS Expanded forehead flaps were used to repair 91 cases of chin and submental scar deformities. According to the postoperative flap survival and complications of flap blood supply, the treatment strategies are as follows: Bilateral cutaneous and subcutaneous pedicled forehead flaps are applied to treat scars in bilaterally symmetrical large-scale scars in Zone LCL. Unilateral pedicled forehead flaps are applied to treat small-scale scars in Zone C and Zone L. Unilateral pedicled plus contralateral vascular anastomosis and unilateral pedicled plus contralateral super thin forehead flaps are applied to treat the moderate-scale scars of Zone LC. Mean follow-up period was 81 months (range 28-131), 93.4% (71/76) was satisfied with appearance and texture of the flaps, 97.4% (74/76) was satisfied with the improvement of neck movement, and 2.6% (2/76) occurred scar recurrence. CONCLUSIONS Five different types of expanded forehead flaps pedicled with superficial temporal vessels can be used to repair differential scar deformities of the chin and submental regions and achieve good therapeutic effects.
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