Vein-supercharged Septocutaneous Perforator-plus Fasciocutaneous Flap:Role Of Venous Supercharging In The Flap In Rabbit Model And Clinical Series

Objective:The purpose of this study is to explore and set up a relatively ideal model of researching the role of venous supercharg-ing in septocutaneous perforator-plus fasciocutaneous flap in rabbit, to explore the effect of venous supecharging on venous drainage of the flap and relevant anatomical basis, and summarize the clinical experience of distally-based peroneal artery perforator-plus sural fasciocutaneous flap with or without Lesser Saphenous Vein anastomosed.Methods:Twelve New Zealand rabbits were used to create the flap models to observe the survival of saphenous artery perforator-plus fascicutaneous flaps containing different perforators. Twelve legs of6rabbits were randomly divided to harvest saphenous artery perforator-plus fascicutaneous flaps with or without supercharging (the pedicle length of2.0cm and width of1.5cm, the skin island length of6.0cm and width of3.0cm), the supercharging vein originated from one of subcutaneous superficial vein in thigh area of femoral vein’perforator. At7days postoperatively, all the flaps’ survival rates were recorded. Through the perforator artery of the sapheneous artery at the base of the fasciocutaneous pedicle, two legs of one recently sacrificed rabbit were executed irrigation of methylene blue and two legs of another living rabbit were executed irrigation of Meglumine Diatrizoate to observe the coloring or developing of vessels (especially the supercharging vein). One saphenous artery perforator-plus fascicutaneous flap with supercharing and another flap without supercharging, which had survived completely10days postoperatively, were irrigated barium sulfate-latex via saphenous artery, and the specimens were performed radiograph and microanatomy. Two saphenous artery perforator-plus fascicutaneous flaps with supercharging and two flaps without supercharging, which had survived completely30days postoperatively, were irrigated barium sulfate-latex via saphenous vein, and the specimens were performed radiograph. The data of8distally-based peroneal artery perforator-plus sural fasciocutaneous flaps with Lesser Saphenous Vein anastomosed and47flaps without Lesser Saphenous Vein anastomosed which were used for repairing the defects in plantar heel were retrospectively reviewed, and the clinical experiences of those flaps were summarized.Results:Three to Five septocutaneous perforators arise from the saphenous vessel from the knee joint to the ankle joint in rabbit, and the location of perforator at3.0cm below the knee joint is relatively constant and sizable. The average survival rates of saphenous artery perforator-plus fascicutaneous flaps with or without venous supercharging were97.3%±6.7%and91.1%±16.9%, respectively (P>0.05). Irrigation of methylene blue demonstrated that most of the methylene blue firstly drained by the perforator vein at the base of flap, then by the perforator vein below the base and fasciocutaneous pedicle and returned to the saphenous vein and Great Saphenous Vein, and finally, a small amount of methylene blue by subcutaneous superficial vein (supercharging vein) in thigh and returned to the femoral vein. Radiography of the Meglumine Diatrizoate showed clearly developed perforator veins and supercharging veins. Irrigation of barium sulfate-latex showed that, the caliber of the subcutaneous superficial veins located at the distal part from pedicle in the vein-supercharged flaps were relatively bigger than the perforator veins and their branches close to the fasciocutaneous pedicle, meanwhile, there were abundant anastomoses between the subcutaneous superficial veins and perforator veins; meanwhile, the caliber and acount of the perforator veins and their branches become enlarged and increased, and continuous development existed in the superficial veins located at the thigh area, femoral vein and its perforator vein. Necrosis rates of Lesser Saphenous Vein anastomosed and not anastomosed distally-based peroneal artery perforator-plus sural fasciocutaneous flaps were12.5%and12.8%(P>0.05).Conclusions:(1) The vein-supercharged saphenous artery perforator-plus fasciocutaneous flap in rabbit is a relatively ideal experimental model which can serve as the flap model for researching the effect of venous supecharging in septocutaneous perforator-plus fasciocutaneous flap.(2) In this study, the vein supercharged or not had no obvious effects on the reliability of the flap; however, supercharged vein executed definite effect on the venous drainge of the flap (especially the distal part from pedicle), and the effect was secondary at early period, then gradually enhanced at later.(3) The Lesser Saphenous Vein supercharged or not had no significant effects on the reliability of the distally-based peroneal artery perforator-plus sural fasciocutaneous flap.