Effects of preserving different veins on flow-through flap survival: An experimental study

Song, Jian; Li, Zonghuan; Yu, Aixi

doi:10.3892/etm.2015.2869

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…The flap survival rate mainly depends on the blood supply [ 2 3 10 11 12 13 14 ], and this explanation applies to all flaps. Not only is a well-vascularized flap needed for tube reconstruction, but a second layer of well-vascularized tissue is also required for wound healing after hypospadias surgery.…”

Section: Discussionmentioning

confidence: 99%

Histological and morphological development of the prepuce from birth to prepubertal age

Erdem,

Caliskan,

Karagul

et al. 2024

Investig Clin Urol

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Purpose To study the histological changes of the preputial tissue from birth to prepubertal age in order to define unnoticed morphological changes. Materials and Methods Prepuce samples were obtained from 79 healthy boys who underwent routine ritual circumcision. Specimens were divided into six groups according to the boys’ age: newborn, 0–1 year of age, 2–3 years of age, 4–5 years of age, 6–7 years of age, and 8–9 years of age. Histologic analysis of the specimens was performed by H&E, Masson’s trichrome, Verhoeff–Von Gieson, immunohistochemical staining. Results Microscopic examinations showed that average epithelial thickness increased after the neonatal period (p=0.001). When collagen fiber density was evaluated, no significant differences between groups were found (p=0.083). When the elastic fibers in the dermis were evaluated, it was determined that the number and thickness of elastic fibers increased with age. Immunohistochemical examinations showed that the number of peripheral nerves marked with S100 was lower in the neonatal period than at other ages (p=0.048). When the vessels marked with CD105 antibody were counted, there was no significant difference between the groups (p=0.078). Conclusions This is the first study to examine the age-related structure of connective tissue elements in the foreskin. Our results showed that the prepuce’s prepubertal maturation process is continuous, and the first 2 years of life are appropriate not only in relation to the physiological effects of age but also the optimum structural changes for wound healing, such as vessel diameter, epithelium thickness, peripheral nerve count.

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Section: Discussionmentioning

confidence: 99%

Histological and morphological development of the prepuce from birth to prepubertal age

Erdem,

Caliskan,

Karagul

et al. 2024

Investig Clin Urol

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“…However, if fewer than 3 vessels are available, options for a disrupted artery might be ETS or ETE (Cho et al, 2016). Further options might be an arteriovenous loupe, (Cavadas, 2008) a T-shaped pedicle in a flow-through flap, (Song, Li, & Yu, 2016, Nemoto, Ishikawa, Kounoike, Sugimoto, & Takeda, 2015 or a perforator-to-perforator flap (Koshima, Nanba, Tsutsui, Takahashi, & Itoh, 2002). Ideally, the selection of recipient vessels should be proximal to the zone of injury.…”

Section: Introductionmentioning

confidence: 99%

Extending the limits of the anterior tibial artery as the recipient vessel for around the knee and proximal lower extremity defect reconstruction using the free anterolateral thigh and gracilis flap

et al. 2017

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Funding informationNone.Purpose: The aim is to describe a technique with orthograde dissection of the anterior tibial artery (ATA) used as the recipient vessel for the end-to-end (ETE) anastomosis in defect reconstruction around the knee and for proximal/middle third leg defects with free anterolateral thigh (ALT) and gracilis flaps.Patients and methods: Between March 2009 and May 2014, 22 patients undergoing lower extremity reconstruction were evaluated. Of those, 4 patients were included. The locations of injury were 3 defects around the knee and 1 defect at the proximal and middle third of the lower leg (mean defect size 18 x 8.5 cm and a range of 17-20 x 5-10 cm). There were 2 cases after trauma and 2 cases with infection. Two free gracilis and 2 free ALT flaps were performed of equal size to the defects. The mean flap pedicle length was 11 cm (range of 7-16 cm) and the mean length of the mobilized recipient vessels was 10.5 cm (range of 6-14 cm).Results: One flap loss (ALT) occurred, requiring a salvage procedure with a latissimus dorsi flap, whereas wound dehiscence at the donor site and a hematoma below the ALT flap was observed in 2 cases, requiring small revision. After a mean follow-up of 52 months (range of 38-87 months), there was stable soft tissue coverage in all patients.Conclusion: By orthograde dissection of the ATA, an adequate vessel length and size may be achieved, improving arc of rotation to successfully cover more distant defects. | I N TR ODU C TI ONLower extremity reconstruction remains challenging to treat, especially if <3 vessels are available. Usually, the etiology is traumatic and highenergy injuries are involved. There is a substantial zone of injury associated with a thrombogenic zone of injury. The mechanism usually comprises endothelial damage by perivascular injury, causing alteration in flow dynamics, which again results in a risk of anastomotic and flap failure. Thus, it is most important that the status of peripheral vascular disease be considered in each patient.Options in a 3-vessel lower extremity microsurgical reconstruction are ETE or end-to-side (ETS) anastomosis. However, if fewer than 3 vessels are available, options for a disrupted artery might be ETS or ETE (Cho et al., 2016). Further options might be an arteriovenous loupe,(Cavadas, 2008) a T-shaped pedicle in a flow-through flap, (Song, Li, & Yu, 2016, Nemoto, Ishikawa, Kounoike, Sugimoto, & Takeda, 2015 or a perforator-to-perforator flap (Koshima, Nanba, Tsutsui, Takahashi, & Itoh, 2002). Ideally, the selection of recipient vessels should be proximal to the zone of injury.Compared to the posterior tibial artery (PTA), the ATA has a much higher incidence of injury with more extensive damage (Chen, Chuang, Chen, Hsu, & Wei, 1994). During surgery, the injury can be at a more proximal level than estimated. This should be kept in mind when the anterior tibial vessels are selected as the recipient site in order to minimize re-exploration and flap failure (Chen, Chuang, Chen, Hsu, & Wei, 1994

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Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps

Wang

Hong

et al. 2020

Ann Plast Surg

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Background The arterialized venous flap (AVF) is appropriate as a flap for hand and foot resurfacing meet the aesthetic demands in the same time. However, the inconsistency of survival rate limited its popularization in clinical settings. The purpose of this study was to investigate the role played by the caliber and location of the artery. Methods Arterialized venous flaps were designed on the abdomen of New Zealand rabbits, and the animals were randomized into 3 groups and 2 groups in experiment 1 and 2, respectively. In experiment 1, the artery flow was restricted with vascular staplers of different calibers. In experiment 2, the artery was anastomosed with the afferent vein in the center or at the margin of the flap. Blood perfusion state, water content, epidermal metabolite levels, and flap survival status were observed in both experiments. Furthermore, outcomes of 12 patients received AVF to resurface soft tissue defects in the digits, hands, and feet between January 2016 and February 2018 were analyzed. Results In experiment 1, compared with the control group, groups with restricted artery showed poor results regarding blood perfusion state, water content, epidermal metabolite levels, and flap survival status. In experiment 2, group with the afferent vein in the center of the flap showed better results mentioned previously. All the flaps survived uneventfully in this study. Two flaps partially failed (20% of the flap area) because of insufficient perfusion. Generally, larger caliber and center-located vein helped the survival of AVF. Conclusions Experimental findings suggested that increased arterial perfusion and center-located vein are beneficial for the survival of AVF. Clinical series proved the findings previously. The problem of inconsistency of AVF can be partially solved by increasing arterial perfusion and dissecting afferent vein into the center of flap, and still, further studies are needed to shed light on the mechanism behind.

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Effects of preserving different veins on flow-through flap survival: An experimental study

Cited by 3 publications

References 34 publications

Histological and morphological development of the prepuce from birth to prepubertal age

Histological and morphological development of the prepuce from birth to prepubertal age

Extending the limits of the anterior tibial artery as the recipient vessel for around the knee and proximal lower extremity defect reconstruction using the free anterolateral thigh and gracilis flap

Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps

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