A preliminary study of the hemodynamics of concealed perforator flap in animal model with ultrasonic Doppler technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAN Yi ¹ , ZHOU Xiang ² , LIANG Jing ² , LI Xubo ² , LI Wenwen ³ , YANG Yutong ³ ,  PAN Fushun ⁴ ,  QI Jian ^2,5

1. Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, Guilin Guangxi, 541001, P. R. China;
2. Department of Microsurgery and Orthopedic Trauma, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;
3. Laboratory Animal Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;
4. Department of Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;
5. Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou Guangdong, 510080, P. R. China;

Corresponding?author：

PAN Fushun, Email: panfush@mail.sysu.edu.cn; QI Jian, Email: qijian@mail.sysu.edu.cn

Keywords：

Concealed perforator flap; saphenous artery; hemodynamics; ultrasonic Doppler technique; pig

DOI：

10.7507/1002-1892.202208081

Video：

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Objective To study the hemodynamic characteristics of concealed perforator flap in mini-pigs by ultrasonic Doppler technique. Methods Seven 7-month-old mini-pigs, weighing 20-25 kg, were included in the study. The saphenous artery perforator flap (group A, n=4), saphenous artery concealed perforator flap (group B, n=5), and saphenous artery concealed perforator flap combined with sarcolemma (group C, n=5) models were established randomly on both hind limbs of pigs. The pigs and flap survival conditions were observed after operation. The percentage of flap survival area was calculated by Photoshop CS5 software at 5 days after operation. Ultrasonic Doppler technique was performed on the flaps before operation and at immediate, 3 days, and 5 days after operation to record the hemodynamic changes of the flaps. The hemodynamic indicators of saphenous artery (inner diameter, peak systoli velocity, resistance index, and blood flow) and saphenous vein (inner diameter, maximum velocity, and blood flow) were recorded. Results At 1 day after operation, 1 pig died of infection, and the rest survived until the experiment was completed. Finally, the 3 flaps of group A, 4 of group B, and 5 of group C were included in the study. The flaps of the 3 groups all showed swelling after operation, which was most significant at 3 days. At 3 days after operation, the flaps in group B showed partial bruising and necrosis. At 5 days after operation, the flaps in groups A and C were basically alive, and the necrosis area of flap in group B increased further. The percentage of flap survival area in groups A, B, and C were 99.7%±0.5%, 74.8%±26.4%, and 100%, respectively. The percentage of flap was significantly lower in group B than in groups A and C (P<0.05). There was no significant difference between groups A and C (P>0.05). There were significant differences in the hemodynamic indicators of saphenous artery and vein between different time points in 3 groups (P<0.05). There was no significant difference in each indicator between groups at each time point (P>0.05). Conclusion Both the saphenous artery concealed perforator flap and the flap combined with sarcolemma have stable blood flow, but the survival area of the latter was better than the former.

Citation： ZHAN Yi, ZHOU Xiang, LIANG Jing, LI Xubo, LI Wenwen, YANG Yutong, PAN Fushun, QI Jian. A preliminary study of the hemodynamics of concealed perforator flap in animal model with ultrasonic Doppler technique. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 46-51. doi: 10.7507/1002-1892.202208081 Copy

1.	Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg, 2003, 50(1): 90-99.
2.	都基山, 李金清. 小血管/毛細血管管腔直徑的調控機制. 組織工程與重建外科, 2020, 16(5): 425-428.
3.	Koshima I, Narushima M, Mihara M, et al. New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb. J Plast Reconstr Aesthet Surg, 2010, 63(1): 140-145.
4.	Mihara M, Hayashi Y, Iida T, et al. Instruments for supermicrosurgery in Japan. Plast Reconstr Surg, 2012, 129(2): 404e-406e.
5.	任振虎, 季彤, 孫堅, 等. 超級顯微外科理念及技術在頜面部整復中的現狀和前景. 中華顯微外科雜志, 2022, 45(4): 468-471.
6.	Ettinger KS, Morris JM, Alexander AE, et al. Accuracy and precision of the computed tomographic angiography perforator localization technique for virtual surgical planning of composite osteocutaneous fibular free flaps in head and neck reconstruction. J Oral Maxillofac Surg, 2022, 80(8): 1434-1444.
7.	詹翼, 李雯雯, 蘇喬, 等. 小型豬隱動脈穿支皮瓣動物模型的建立. 中華顯微外科雜志, 2019, 42(3): 264-267.
8.	Zhan Y, Zhu H, Li W, et al. Saphenous artery perforator flaps in minipigs: anatomical study and a new experimental model. J Invest Surg. 2021, 34(5): 486-494.
9.	吳東方, 劉東紅, 方芳, 等. 大鼠腹壁淺動脈皮瓣游離移植至腋窩模型的構建技巧. 中國臨床解剖學雜志, 2022, 40(3): 271-276.
10.	da Silva LA, Lira EC, Leal LB, et al. Prevention of necrosis in ischemic skin flaps using hydrogel of Rhizophora mangle. Injury, 2022, 53(7): 2462-2469.
11.	Morarasu S, Ghetu N, Coman CG, et al. Role of ultrahigh frequency ultrasound in evaluating experimental flaps. J Reconstr Microsurg, 2021, 37(4): 385-390.
12.	Abdelwahab M, Patel PN, Most SP. The use of indocyanine green angiography for cosmetic and reconstructive assessment in the head and neck. Facial Plast Surg, 2020, 36(6): 727-736.
13.	Hong JP, Hur J, Kim HB, et al. The use of color duplex ultrasound for local perforator flaps in the extremity. J Reconstr Microsurg. 2022, 38(3): 233-237.
14.	王世強, 張莉, 陳琳, 等. 大鼠股后側穿支皮瓣模型及血流檢測方法的初步研究. 中華手外科雜志, 2017, 33(6): 468-471.
15.	劉族安, 馬亮華, 孫傳偉, 等. 靜脈超引流技術在游離皮瓣移植中的應用. 中華顯微外科雜志, 2019, 42(4): 335-338.
16.	Wang X, Pan J, Xiao D, et al. Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats. Microsurgery, 2020, 40(8): 874-880.
17.	Zhang W, Zhu W, Li X, et al. Effects of distal arterial supercharging and distal venous superdrainage on the survival of multiterritory perforator flaps in rats. J Invest Surg, 2022, 35(7): 1462-1471.
18.	曾秀安, 厲孟, 楊其兵, 等. 二甲基乙二酰基甘氨酸對跨區穿支皮瓣ChokeⅡ區血管生成的影響機制研究. 中國修復重建外科雜志, 2022, 36(2): 224-230.
19.	Chen M, Li X, Jiang Z, et al. Visualizing the pharmacologic preconditioning effect of botulinum toxin type A by infrared thermography in a rat pedicled perforator island flap model. Plast Reconstr Surg, 2019, 144(6): 1016e-1024e.
20.	Mao Y, Li H, Ding M, et al. Comparative study of choke vessel reconstruction with single and multiple perforator-based flaps on the murine back using delayed surgery. Ann Plast Surg, 2019, 82(1): 93-98.
21.	Jiang Z, Li X, Chen M, et al. Effect of endogenous vascular endothelial growth factor on flap surgical delay in a rat flap model. Plast Reconstr Surg, 2019, 143(1): 126-135.
22.	柳志錦, 巨積輝, 劉勝哲, 等. 以筋膜蒂相連的單穿支雙葉型股前外側皮瓣修復四肢創面的臨床研究. 中國臨床解剖學雜志, 2021, 39(5): 593-597.

1. Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg, 2003, 50(1): 90-99.
2. 都基山, 李金清. 小血管/毛細血管管腔直徑的調控機制. 組織工程與重建外科, 2020, 16(5): 425-428.
3. Koshima I, Narushima M, Mihara M, et al. New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb. J Plast Reconstr Aesthet Surg, 2010, 63(1): 140-145.
4. Mihara M, Hayashi Y, Iida T, et al. Instruments for supermicrosurgery in Japan. Plast Reconstr Surg, 2012, 129(2): 404e-406e.
5. 任振虎, 季彤, 孫堅, 等. 超級顯微外科理念及技術在頜面部整復中的現狀和前景. 中華顯微外科雜志, 2022, 45(4): 468-471.
6. Ettinger KS, Morris JM, Alexander AE, et al. Accuracy and precision of the computed tomographic angiography perforator localization technique for virtual surgical planning of composite osteocutaneous fibular free flaps in head and neck reconstruction. J Oral Maxillofac Surg, 2022, 80(8): 1434-1444.
7. 詹翼, 李雯雯, 蘇喬, 等. 小型豬隱動脈穿支皮瓣動物模型的建立. 中華顯微外科雜志, 2019, 42(3): 264-267.
8. Zhan Y, Zhu H, Li W, et al. Saphenous artery perforator flaps in minipigs: anatomical study and a new experimental model. J Invest Surg. 2021, 34(5): 486-494.
9. 吳東方, 劉東紅, 方芳, 等. 大鼠腹壁淺動脈皮瓣游離移植至腋窩模型的構建技巧. 中國臨床解剖學雜志, 2022, 40(3): 271-276.
10. da Silva LA, Lira EC, Leal LB, et al. Prevention of necrosis in ischemic skin flaps using hydrogel of Rhizophora mangle. Injury, 2022, 53(7): 2462-2469.
11. Morarasu S, Ghetu N, Coman CG, et al. Role of ultrahigh frequency ultrasound in evaluating experimental flaps. J Reconstr Microsurg, 2021, 37(4): 385-390.
12. Abdelwahab M, Patel PN, Most SP. The use of indocyanine green angiography for cosmetic and reconstructive assessment in the head and neck. Facial Plast Surg, 2020, 36(6): 727-736.
13. Hong JP, Hur J, Kim HB, et al. The use of color duplex ultrasound for local perforator flaps in the extremity. J Reconstr Microsurg. 2022, 38(3): 233-237.
14. 王世強, 張莉, 陳琳, 等. 大鼠股后側穿支皮瓣模型及血流檢測方法的初步研究. 中華手外科雜志, 2017, 33(6): 468-471.
15. 劉族安, 馬亮華, 孫傳偉, 等. 靜脈超引流技術在游離皮瓣移植中的應用. 中華顯微外科雜志, 2019, 42(4): 335-338.
16. Wang X, Pan J, Xiao D, et al. Comparison of arterial supercharging and venous superdrainage on improvement of survival of the extended perforator flap in rats. Microsurgery, 2020, 40(8): 874-880.
17. Zhang W, Zhu W, Li X, et al. Effects of distal arterial supercharging and distal venous superdrainage on the survival of multiterritory perforator flaps in rats. J Invest Surg, 2022, 35(7): 1462-1471.
18. 曾秀安, 厲孟, 楊其兵, 等. 二甲基乙二酰基甘氨酸對跨區穿支皮瓣ChokeⅡ區血管生成的影響機制研究. 中國修復重建外科雜志, 2022, 36(2): 224-230.
19. Chen M, Li X, Jiang Z, et al. Visualizing the pharmacologic preconditioning effect of botulinum toxin type A by infrared thermography in a rat pedicled perforator island flap model. Plast Reconstr Surg, 2019, 144(6): 1016e-1024e.
20. Mao Y, Li H, Ding M, et al. Comparative study of choke vessel reconstruction with single and multiple perforator-based flaps on the murine back using delayed surgery. Ann Plast Surg, 2019, 82(1): 93-98.
21. Jiang Z, Li X, Chen M, et al. Effect of endogenous vascular endothelial growth factor on flap surgical delay in a rat flap model. Plast Reconstr Surg, 2019, 143(1): 126-135.
22. 柳志錦, 巨積輝, 劉勝哲, 等. 以筋膜蒂相連的單穿支雙葉型股前外側皮瓣修復四肢創面的臨床研究. 中國臨床解剖學雜志, 2021, 39(5): 593-597.

Chinese Journal of Reparative and Reconstructive Surgery

A preliminary study of the hemodynamics of concealed perforator flap in animal model with ultrasonic Doppler technique

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