VASCULAR RESPONSES IN SKIN-FASCIAL FLAP IN SERIES WITH THE VIOLATION OF HIS DONOR AREA
Reactions of the blood flow in non-free and free fasciocutaneous flaps at different stages of surgical treatment and postoperative period are of great interest for microsurgeons and intensivists, which is connected with circulation disturbances in a flap after decoupling, to some or other extent, of the flap circulation to the donor zone. The aim of this work is to study experimentally the reaction of the blood flow of non-free inferior epigastric fasciocutaneous flap at a different extent of flap disconnection to the donor zone. Materials and methods. Objects of study were white outbread rats of both genders with a body mass of 180-200 g. Two series of experiments have been carried out: I series - anatomical study of peculiarities of the inferior epigastric flap of white rat (40 animals) in its classical mapping through macro- and microdissection; II series - autotransplantation operations with transposition of non-free epigastric flap with intact vascular pedicle and three Вопросы реконструктивной и пластической хирургии № 3(50) сентябрь 2014 Селянинов К.В. versions of treatment of the vascular pedicle. To study the blood inferior of skin of the rat inguinal region, the method of blood flow injection with Gerot blue mass with the following clearing of specimens by the Spalteholz method (1921) in D.A. Zhdanov modification (1943) was used. Clinical assessment of the state of fasciocutaneous flaps (1st-10th days after the operation) was based on the following criteria: edema, capillary response, severity of peeling of flap skin cover, presence of necrosis. Results. At the noncomplicated postoperative period, the complete acceptance of the non-free low epigastric flap with the intact vascular pedicle normally occurred at the 9th-10th day with formation of vascular connections to surrounding tissues by the 14th day. After surgical manipulations at the flap axial vessels (removal of paravasal structures and, correspondingly, with periarterial, perivenous, and combined sympathectomy of axial vessels of the epigastric fasciocutaneous flap), long (first 5 days) hemodynamic compromise (adenoma, peripheral cyanosis) caused by microvasculature disbalance are observed. Flap necrosis after perivenous sympathectomy of vein was caused by development of venous thrombosis. Not only axial vessels, but also vessels of paravasal fiber supplying blood to the central zone of the flap take part in blood circulation of skin of the epigastric flap of a white rat. Conclusions. Separation of a non-free fasciocutaneous flap from the angiosome structure is accompanied by transitory and, in some cases, permanent circulatory disturbances.
Keywords
paravasal vessels,
non-free flap,
inferior epigastric flap,
sympathectomy,
angiosome,
vascular pedicle,
balanced blood flow,
fasciocutaneous flap,
паравазальные сосуды,
нижний эпигастральный лоскут,
несвободный лоскут,
ангиосомы,
симпатэктомия,
сбалансированный кровоток,
сосудистая ножка,
кожно-фасциальный лоскутAuthors
Всего: 1
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