CAUSES OF CAPILLARY HYPOPERFUSION IN MICROVASCULAR FLAPS FOLLOWING THEIR REPERFUSION (EXPERIMENTAL STUDY)

Evidence of epigastric microvascular flaps hypoperfusion after their replantation (transplantation) is presented in the article. The aim of the study: experimental investigation of vascular bed state in microvascular epigastric flaps ina condition of disturbed cardiosynchronized vasomotor sympathetic reflex. № 4 (59) декабрь’2016 Вопросы реконструктивной и пластической хирургии Экспериментальная хирургия 27 Material and methods. The object of the study were pubertal white rats of both sexes weighing 250-300 g (n = 60). Anesthesia was performed by intramuscular administration of “Zoletil-50” solution in a dose of 5 mg per 1 kg of body weight. The animals were divided into three groups: Group I rats (n = 20) underwent performing an access to a. et v. epigastrica superficialis with preservation of periadventitial tissue, then precisionally, via 30G insulin needle, a. epigastrica superficialis with Gerota mass was perfused. After perfusion of arterial bed, the skin channel in boundaries of epigastric flap, lifting of the inferior epigastric flap was performed based upon F. Finseth method in the standard marking (2 . 3 cm), followed by the intersection of the surface epigastric neurovascular bundle. Group II rats (n = 20) underwent lifting of free inferior epigastric flap with the application of based upon P.G. van der Sloot (2002) method with precise isolation of the limb skin graft (superficial epigastric vessels) to femoral vessels with subsequent microvascular anastomoses in an “end-to-end” at the level a. et v. femoralis. After microvascular reperfusion of epigastric flap and quality check of anastomosts performed, antegrade perfusion of the flap using Gerota mass was performed via a. epigastrica superficialists. The III group rats (n = 20) underwent lifting of free inferior epigastric flap with the application of arteriovenous anastomoses at the level of femoral vessels proximal to the point of origin of superficial epigastric neurovascular bundle. Using this model, retrograde reperfusion of epigastric free flap tissues was performed immediately after the arterialization of its venous bed (the RF patent № 2486605). After retrograde blood flow beginning in the flap, its retrograde perfusion using Gerota mass was performed via a. epigastrica superficialis. Status of vascular bed in microvascular epigastric flaps in conditions of impaired cardiosynchronized vasomotor sympathetic reflex was tested using macropreparations and histological sections with the assessment of the perfusion of venous, arterial and microcirculatory bed in epigastric microvascular flaps. Conclusions. Cardiosynchronized vasomotor sympathetic reflex provides full opening of arterioles and perfusion of the skin capillary bed within epigastric flap boundaries. Transplantation (replantation) of microvascular flap is followed by loss of vascular tone neurogenic control and by interrupting of pulse wave passage on the flap artery which leads to disturbed opening mechanism of arterioles and capillary hypoperfusion. Hypertension in venous bed of microvascular flaps may be followed by retrograde movement of blood to the level of arterioles.

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