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Source publication
Background:
Most of the techniques used to investigate choke vessels are indirect. The aim of the present study is to assess the effectiveness of percutaneous endoscopy in direct real-time visualization of choke vessels in rat perforator flap models.
Methods:
A classic perforator flap on the rat dorsum was designed (n = 12). An additional incisi...
Contexts in source publication
Context 1
... of choke vessels using percutaneous endoscopy At one-hour post operation, the choke arteries constricted, whereas the choke veins began to dilate and were filled with blood ( Figure 4 A). On postoperation day 1, both the choke arteries and veins had dilated to significantly larger diameters and exhibited tortuous features, which indicated increased blood flow to the perforator flap from the left iliolumbar arteries ( Figure 4 B). ...
Context 2
... of choke vessels using percutaneous endoscopy At one-hour post operation, the choke arteries constricted, whereas the choke veins began to dilate and were filled with blood ( Figure 4 A). On postoperation day 1, both the choke arteries and veins had dilated to significantly larger diameters and exhibited tortuous features, which indicated increased blood flow to the perforator flap from the left iliolumbar arteries ( Figure 4 B). On postoperation day 4, the maximum diameters of the choke arteries were reached, as was the peak tortuosity. ...
Context 3
... postoperation day 4, the maximum diameters of the choke arteries were reached, as was the peak tortuosity. However, the diameters of the choke veins began to decrease ( Figure 4 C). On postoperation day 7, the extent of dilation and the degree of tortuosity of the choke vessels decreased but remained greater than the original levels ( Figure 4 D). ...
Context 4
... the diameters of the choke veins began to decrease ( Figure 4 C). On postoperation day 7, the extent of dilation and the degree of tortuosity of the choke vessels decreased but remained greater than the original levels ( Figure 4 D). During the whole process, no apparent neovascularization was detected. ...
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Citations
... They have similar characteristics: to accelerate acute or chronic wound healing by stimulating reepithelisation, angiogenesis and collagen synthesis, concomitant with the antibacterial actions [4]. Different imaging techniques have been described to analyse the effects of the administrated substances on the rat dorsal skin flap such as the Doppler ultrasonography, infrared thermography or percutaneous endoscopy [2,7,13,17]. Blood samples provide researchers with information regarding coagulation status, inflammatory process, blood loss quantity after surgery and the level of oxidative stress [3]. ...
Background
This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions.
Methods
Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected.
Results
Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012).
Conclusion
These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
Background
As a significant bridge between perforasomes, choke vessels are the key structure of blood supply expansion, also a prerequisite for preventing distal ischemic necrosis of the multiterritory perforator flap, where the remodeling of choke vessels after flap elevation plays an essential role. This systematic review highlights the underlying mechanisms and clinical ways to promote remodeling of choke vessels, as well as experimental observation approaches to further guide researchers.
Methods
A systematic review was conducted from 1975 to 2023 through PubMed, EMBASE, Web of Science, and Cochrane database with the key words “choke vessels” and “perforator flap” to investigate the mechanisms and ways to promote remodeling of choke vessels as well as observation approaches. The inclusion criteria and exclusion criteria were set to screen the literature.
Results
A total of 94 literatures were obtained through database retrieval. After removing the duplicate literature, reading the title and abstract, and reviewing the full text finally, 33 articles were included in the final study.
Conclusions
The underlying remodeling of choke vessels may be related to fluid shear stress, hypoxia, and inflammation. The clinical ways to promote remodeling of choke vessels include surgical delay, arterial supercharge, venous superdrainage, drugs, and stem cells. Various experimental methods of observing microvascular morphology allow for a comprehensive research of choke vessels.
