The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve
XIE Yun，ZOU Wen-xuan， FANG Fang， ZHANG Qi，YE Jun-jian，ZHUANG Yue-hong
Chinese Journal of Clinical Anatomy ›› 2017, Vol. 35 ›› Issue (1) : 25-30.
The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve
Objective To investigate whether the sural nerve emanates sympathetic fibers to its accompanying artery, regulating its tone, and the hemodynamic change of the proximally-based sural neurovascular flap brought about by section of the sural nerve at its origin. Methods In 17 rabbits, two rabbits were used as the normal control group, from which the sural neurovascular bundles were harvested without flap creation, and the other 15 rabbits were randomly divided into two groups with 15 sides of hind limbs in each group: a nerve transection group, where the sural nerve was transected at its origin after creation of the proximally-based sural neurovascular flap, and a nerve preservation group, where the sural nerve was untouched after flap creation. The latter two groups were continued to be allocated respectively to three sub-groups according to the time points, i.e., 3d, 5d and 7d after flap creation. The rabbits were executed at the corresponding time points and the sural neurovascular bundles were harvested for glyoxylic acid staining. An infrared thermal imager was used for measurement of the average temperature of the flaps within 24h after flap harvest. Results The intensity of green fluorescent staining within the sural nerve and around the tunica externa of the sural artery showed a synchronized gradual decline in the nerve transection group at 3d, 5d and 7d after flap harvest. Significant difference of fluorescent intensity could be detected among the groups (F=13.563, P=0.004). The fluorescent intensity of the sural neurocutaneous bundle showed no decline in the nerve preservation group at the postoperative three time points. The average temperature of the flaps in the nerve transection group was higher than that in the nerve preservation group starting from 2h after flap harvest (P<0.05). Conclusion The sural nerve has issued sympathetic fibers to the accompanying arteries, regulating its vascular tone. The microvascular circulation within the proximally-based sural neurocutaneous flap could improve if the sural nerve is divided at its origin, leading to possible increased flap survival.
Sympathetic fibers / Sural nerve / Flap / Infrared thermal imager / Hemodynamics
[1] Bertelli JA, Khoury Z. Neurocutaneous island flaps in the hand: anatomic basis and preliminary results [J]. Br J Plast Surg, 1992, 45(8):586-590.
[2] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg [J]. Plast Reconstr Surg, 1992, 89(6):1115-1121.
[3] 钟云祥，钟强，张雄辉，等 负压封闭引流联合小腿皮神经皮瓣修复足踝部软组织缺损 [J].临床骨科杂志,2016,19(1)：58-60.
[4] 张世民，徐达传，顾玉东，等.链型皮瓣的血管基础及临床意义[J].中国临床解剖学杂志, 2004, 22(1):13-16.
[5] 高建明，徐达传，王众，等.带蒂股后皮神经营养血管皮瓣的解剖与临床应用 [J]. 中国临床解剖学杂志, 2004, 22(1):26-28.
[6] 吴农欣，徐永清，覃励明，等.足背外侧皮神经营养血管皮瓣的应用解剖学 [J].中国临床解剖学杂志, 2006, 24(2):142-144.
[7] Morgan RF, Reisman NR, Wilgis EF. Anatomic localization of sympathetic nerves in the hand [J]. J Hand Surg Am, 1983, 8(3):283-288.
[8] 杨力，朱小平，郭贤钊，等.腓肠外侧皮神经营养血管皮瓣在小腿组织缺损修复中的应用[J] 重庆医学, 2015, 44(15)：2106-2108.
[9] 曾学文，宋朝辉，李朝阳, 等. 顺行及逆行腓肠神经营养皮瓣的临床应用体会[J]. 中国美容医学杂志，2010，19(10):1427-1429.
[10] 王彦生，沙德峰，田芙蓉，等. 臂内侧皮神经营养血管筋膜皮瓣的临床应用[J]. 中国修复重建外科杂志, 2015, 19(7)：519-520.
[11]谢逸波，李培浩，樊滔，等. 隐神经营养血管皮瓣结合组合外固定架并腿修复对侧小腿创面[J]. 广东医学，2014，35(16)：2566-2567.
[12] de Weerd L， Miland AO，Mercer JB. Perfusion dynamics of free DIEP and SIEA flaps during the first postoperative week monitored with dynamic infrared thermography [J]. Ann Plast Surg, 2009, 62(1): 42-47.
[13] Muntean MV，Strilciuc S，Ardelean F, et al. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators[J].Med Ultrason, 2015, 17(4):503-508.
[14] Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging [J]. Plast Reconstr Surg, 2016, 137(1):39-41.
[15] Just M, Chalopin C, Unger M, et al. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences [J]. Eur Arch Otorhinolaryngol, 2016, 273(9):2659-2667.
[16] de Weerd L, Weum S, Mercer JB. Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge [J].Ann Plast Surg, 2014, 72(2):261.
[17] Mitchell JA. An investigation of an autonomic innervation of the vertebral artery using monoamine histofluorescence [J]. Eur J Histochem, 2004, 48(2):115-120.
[18] Axelsson S, Bjorklund A, Falck B, et al. Glyoxylic acid condensation: a new fluorescence method for the histochemical demonstration of biogenic monoamines [J]. Acta Physiol Scand, 1973, 87(1):57-62.
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