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Lancien U, Charbonnier B, Weiss P, Corre P, Perrot P. Rat Perforator and Skin Vessels Vascular Mapping: An Original Anatomical Study About 140 Vessels and Literature Review. J Surg Res 2023; 288:298-308. [PMID: 37058986 DOI: 10.1016/j.jss.2023.03.015] [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: 11/15/2022] [Revised: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Recent microsurgical reconstruction techniques benefit from the use of skin and perforator flaps that spare the donor sites. Studies on these skin flaps in rat models are numerous but there is currently no reference regarding the position of the perforators, their caliber, and the length of the vascular pedicles. METHODS We performed an anatomical study on 10 Wistar rats and 140 vessels: cranial epigastric (CE), superficial inferior epigastric (SIE), lateral thoracic (LT), posterior thigh (PT), deep iliac circumflex (DCI) and posterior intercostal (PIC) vessels. The evaluation criteria were the external caliber, the length of the pedicle, and the position of the vessels reported on the skin surface. RESULTS Data from the six perforator vascular pedicles are reported, with figures illustrating the orthonormal reference frame, the representation of the vessel's position, the cloud of points corresponding to the various measurements, and the average representation of the collected data. The analysis of the literature does not find similar studies; the different vascular pedicles are discussed as well as the limitations of our study: evaluation of cadaver specimen, presence of the very mobile panniculus carnosus, other perforator vessels not evaluated as well as the precise definition of perforating vessels. CONCLUSIONS Our work describes the vascular calibers, pedicle lengths, and location of birth and arrival at the skin of the perforator vessels PT, DCI, PIC, LT, SIE, and CE in rat animal models. This work, without an equivalent in the literature, lays the foundation for future studies about flap perfusion, microsurgery, and super microsurgery learning.
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Affiliation(s)
- Ugo Lancien
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France.
| | - Baptiste Charbonnier
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Weiss
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Corre
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Maxillofacial surgery unit, Nantes University Hospital, Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Perrot
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
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Zhang D, Chen H, Hu X, Yu A. Photoacoustic microscopy: a novel approach for studying perforator skin flap in a mouse model. Quant Imaging Med Surg 2021; 11:4365-4374. [PMID: 34603991 DOI: 10.21037/qims-21-135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
Background A comprehensive understanding of cutaneous microvessels is key to the design and use of the perforator skin flap. Compared with the various imaging technologies that have been applied in the clinical practice of the perforator skin flap, photoacoustic microscopy (PAM) is a very promising noninvasive imaging modality with high resolution and deep penetration in biological tissues. Methods PAM was employed to explore its multiple applications in a perforator skin flap. The following experiments were then conducted in 3 parts. In part 1, 7 mice were used to obtain the preoperative perforator mapping on the mouse back. In parts 2 and 3, 7 mice were used to design and harvest the multiterritory perforator flap. The status of the flap and the morphological changes of choke vessels were subsequently observed by PAM at several time points. Results The results showed that PAM could visualize and assess the vascular physiological and pathological conditions of the skin tissue in real time in vivo with high spatial and temporal resolution. It could also provide preoperative perforator mapping, including the total number of perforators, localization, vascular territories, and diameter. Furthermore, it could offer a quantitative, objective method to monitor the status of the perforator skin flap, and was capable of noninvasive characterization of the changes of choke vessels that play an important role in multiterritory perforator skin flap expansion and survival. Conclusions PAM has great potential to be an effective and precise quantitative imaging tool for perforator skin flap research, such in as flap design, monitoring, and choke vessel observation.
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Affiliation(s)
- Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hairen Chen
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiang Hu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Xie Y, Fang F, Su P, Xiao J, Zheng H, Zhuang Y. Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications. Wound Repair Regen 2020; 28:823-833. [PMID: 32902063 DOI: 10.1111/wrr.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 12/01/2022]
Abstract
The process of reinnervation, an important component of functional restoration after flap transfer, is understudied, making it necessary to carry out a further investigation for delineation of the exact timeline. Seventy-six Sprague-Dawley rats were used as the experimental animals. An anatomic study was first conducted to clarify the pattern of nerve distribution in the dorsal skin of 16 rats. Afterward, a myocutaneous flap was harvested on the right flanks of 40 rats, which were then assigned into seven time points. At each time point, skin samples were harvested and immunofluorescent staining was performed using α-Bungarotoxin, and antibodies against NF-200, p75, α-SMA, and TH. One-way analysis of variance was adopted for comparison of nerve density after surgery. For evaluation of functional return, cutaneous trunci muscle reflex (CTMr) test was performed on 10 additional rats, and the Chi-square test was used for comparison of reflex intensity among six time points after surgery. The outcomes revealed that the cutaneous branches from the intercostal nerves and the dorsothoracic nerve from the brachial plexus could be found entering the dorsal skin, distributed in the skin proper and the panniculus carnosus, respectively. After flap surgery, full spontaneous reinnervation of the skin proper and vessels within the flaps could be achieved at day 180. However, if the stumps of cutaneous branches of the intercostal nerves were damaged, the nerve density in the skin proper underwent a 2/3 decline. The panniculus carnosus in the cranial part had a much better reinnervation than that in the caudal part. The CTMr test showed that the flap could regain most of its sensate and motor activity. Our study shows that strong spontaneous reinnervation could be expected after flap surgery. The pattern of the original nerve distribution in both the recipient and donor sites may have a big impact on the reinnervation of the flap.
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Affiliation(s)
- Yun Xie
- Orthopedic Department, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fang Fang
- Department of Pharmacology, Fujian Medical University, Fuzhou, China
| | - Ping Su
- Department of Pathology and Pathophysiology, Xiamen Medical College, Xiamen, China
| | - Jiting Xiao
- Fujian Key Laboratory of Brain Aging and Neurodegenerative Diseases, Institute of Clinical Applied Anatomy, School of Basic Medicines, Fujian Medical University, Fuzhou, China
| | - Haibo Zheng
- Department of Medical Physics, Fujian Medical University, Fuzhou, China
| | - Yuehong Zhuang
- Orthopedic Department, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Brain Aging and Neurodegenerative Diseases, Institute of Clinical Applied Anatomy, School of Basic Medicines, Fujian Medical University, Fuzhou, China
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Fang F, Liu M, Xiao J, Zhuang Y. Arterial Supercharging Is More Beneficial to Flap Survival Due to Quadruple Dilation of Venules. J Surg Res 2020; 247:490-498. [DOI: 10.1016/j.jss.2019.09.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/05/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Fang F, Zhang Z, Wang K, Wang F, Zheng HP, Zhuang Y. The Skin Bridge Is More Important as an Additional Venous Draining Route in a Perforator-Plus Flap. J Surg Res 2019; 234:40-48. [DOI: 10.1016/j.jss.2018.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/06/2018] [Accepted: 09/07/2018] [Indexed: 12/27/2022]
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Zhao G, Zhang X, Xu P, Mi JY, Rui YJ. The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats. Injury 2018; 49:2147-2153. [PMID: 30293870 DOI: 10.1016/j.injury.2018.09.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats. METHODS A total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of "choke vessels" was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day. RESULTS On the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001). CONCLUSION Irisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.
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Affiliation(s)
- Gang Zhao
- Soochow University, Soochow, Jiangsu, China; Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Xin Zhang
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Peng Xu
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Jing-Yi Mi
- Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China
| | - Yong-Jun Rui
- Soochow University, Soochow, Jiangsu, China; Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated Soochow University, Wuxi, Jiangsu, China.
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Park JW, Mun GH. Comparative analysis of the effect of antihypertensive drugs on the survival of perforator flaps in a rat model. Microsurgery 2017; 38:310-317. [DOI: 10.1002/micr.30286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 11/17/2017] [Accepted: 12/08/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Jin-Woo Park
- Department of Plastic Surgery; Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu; Seoul 135-710 South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery; Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu; Seoul 135-710 South Korea
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The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy. Arch Plast Surg 2017; 44:509-515. [PMID: 29069878 PMCID: PMC5801789 DOI: 10.5999/aps.2017.00934] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/02/2017] [Accepted: 09/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.
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Reply. Plast Reconstr Surg 2017; 140:354e-355e. [DOI: 10.1097/prs.0000000000003534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hemodynamic Study of Three Patterns of Flaps on Rats with a Novel Panoramic Photographing Technique Involved. Plast Reconstr Surg 2017; 140:353e-354e. [PMID: 28418980 DOI: 10.1097/prs.0000000000003533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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