THE VALUE OF VASA NERVORUM IN SKIN BLOOD SUPPLY MICROSURGICAL FLAPS

The paper demonstrates the possibility of blood supply of the neutral flap skin by intra- and perineural vessels of the corresponding cutaneous nerves. Goal: experimental study of the possible participation of vasa nervorum in blood supply of fasciocutaneous flaps of white rats. Material and methods. Objects of study were mature White Wistar rats, both male and female, with mass of 250-300 g (n = 58). Anesthesia was achieved by intramuscular injection of Zoletil-50 solution in dose of 5 mg per 1 kg of body mass. № 1(52) март, 2015 Вопросы реконструктивной и пластической хирургии Экспериментальная хирургия 45 The rats were divided into three groups: I group (n = 13) - 11 rats received experimental operations autotransplantation of neurocutaneous lumbar flap by M. Akyurek (2004) with its transformation into the neutral one through precision ligation (under optical magnification with MBS-10 microscope) of accompanying (supplying) n. cutaneous femoris lateralis vessels. II group (n = 13) - 11 rats received operations of autotransplantation of axial non-free fasciocutaneous low epigastric flap by F. Finseth in standard markup (2 . 3 cm) with its transformation into non-free neutral one through precision ligation in flap pedicle of a. et v.epigastrica superficialis with n. epigastricus kept intact. To determine the presence of nerve fibers in the skin of the classical epigastric flap transformed into the neutral one, the Bielshowsky- Gross method of section impregnation by silver nitrate in A. I. Ryzhov modification (1961) was used. III group (n = 32) - in this group, the neurocutaneous territory of n. epigastricus superficialis was studied anatomically by the method of macro- and micropreparation in 4 rats. With allowance made for the boundaries of the neurocutaneous territory of n. epigastricus, 11 rats received operation of autotransplantation of non-free neutral epigatric flap in its standard size (2 . 2 cm). Then, 11 more rats received the operation of autotransplantation of smaller neutral epigastric flap (1.5 . 1.5 cm). The clinical assessment of the state of non-free fasciocutaneous neutral flaps in the early postoperative period (1st-10th days) was performed by such criteria as edema, capillary response, severity of flap skin sloughing, presence of necrosis. Conclusions. 1. Longitudinal vessels of vasa nervorum of external epineurium of cutaneous sensory nerves (n. cutaneous femoris lateralis, n. epigastricus) reach their neurocutaneous territories and take part in blood supply of the skin of corresponding neutral flaps. 2. Transformation of the axial low epigastric fasciocutaneous flap in standard markup into the neutral fasciocutaneous flap is impossible. 3. Vasa nervorum of cutaneous sensory nerves is an additional source of blood supply of axial fasciocutaneous flap in the cases, when the sensory nerve enters into the flap pedicle, and the angiosome boundaries coincide with the boundaries of the neurocutaneous territory of this nerve within the boundaries of the corresponding flap.

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