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R Vijayan, F Al-Aswad, R Y Kannan
The centre ground in the world of flaps have over time, gradually shifted from tubed pedicled, random-pattern, axial-pattern, pedicled, free and currently, to free-styled flaps. These concepts are broadly based on the angiosome-perforasome concept. In this case report, we illustrate how the concept of venosome capture can be transposed onto reverse-flow flaps with the aid of venous supercharging. Moreover, if this is seen from the free-styled flap perspective, it requires supermicrosurgical expertise. This case report hence, serves as a fusion of all the above concepts...
November 24, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Ulrich Rother, Katrin Krenz, Werner Lang, Raymund E Horch, Axel Schmid, Marco Heinz, Alexander Meyer, Susanne Regus
OBJECTIVE: In recent years, a controversial discussion about the clinical relevance of the angiosome concept during tibial angioplasty has developed. Therefore, we conducted a prospective study to evaluate the angiosome concept on the level of microcirculation during tibial vascular interventions. METHODS: Thirty patients with isolated tibial angioplasty were examined prospectively. Macrocirculation was evaluated by measurement of the ankle-brachial index (ABI)...
November 7, 2016: Journal of Vascular Surgery
Kristýna Špillerová, Fausto Biancari, Nicla Settembre, Anders Albäck, Maarit Venermo
BACKGROUND: The definition of angiosome-targeted revascularization is confusing, especially when a tissue lesion affects several angiosomes. Two different definitions of direct revascularization exist in the literature. The study aim was (1) to compare the 2 definitions of direct revascularization in patients with foot lesions involving more than one angiosome and (2) to evaluate which definition better predicts clinical outcome. METHODS: This study cohort comprises 658 patients with Rutherford 5-6 foot lesions who underwent infrapopliteal endovascular or surgical revascularization between January 2010 and July 2013...
September 29, 2016: Annals of Vascular Surgery
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
Ines E Tinhofer, Chieh-Han J Tzou, Dominik Duscher, Michael S Pollhammer, Wolfgang J Weninger, Georg M Huemer, Manfred Schmidt
BACKGROUND: Fasciocutaneous flaps supplied by discrete perforator arteries can be raised in numerous parts of the human body and are routinely used in plastic surgery. The aim of this anatomical investigation was to provide a description of the vascular supply of the medial upper arm, to localize and measure the perforator arteries and to define potential perforator flap dimensions in pendency of individual anatomical conditions. MATERIAL AND METHODS: A total of 20 upper limbs from 11 fresh cadavers were examined...
September 16, 2016: Microsurgery
C Caradu, A S Battut, C Gonthier, D Midy, E Ducasse
One third of patients with critical limb ischemia (CLI) has below the knee lesions and requires a restoration of direct blood flow into the foot. However, many of these patients are ineligible for open surgery. The primary goals thus become pain relief and limb salvage over patency. The angiosome concept helps determine the target artery to treat in priority. The endovascular approach has decreased morbidity and mortality rates compared to distal bypass surgery; while subintimal retrograde, trans-collateral and loop techniques push the limits of open surgery by reopening the plantar arch, thereby improving run-off...
September 1, 2016: Journal des Maladies Vasculaires
Andrew P Murdoch, Sam N Greenaway, Laura J Owen, Alan Danielski
OBJECTIVES: To confirm the anatomic location of the cranial cutaneous branch of the saphenous artery (CCSA), delineate the angiosome of the CCSA, and provide guidelines for clinical use of an axial pattern flap based on the CCSA. STUDY DESIGN: Anatomic study. ANIMALS: Greyhound cadavers (n=10). METHODS: Shortly after euthanasia, the CCSA was identified and isolated in each hindlimb. Methylene blue and radiographic perfusion studies were performed...
October 2016: Veterinary Surgery: VS
X Y Tao, Z W Zhou, L H Yang, W Y Gao, L Wang, J Ding, X L Feng
OBJECTIVE: To observe the effects of pretreatment with dimethyloxalylglycine (DMOG) on the survival of multi-territory perforator flap and the vessels of choke zone (CZ) 2 in rat, and to explore related mechanism. METHODS: Sixty adult SD rats were divided into group DMOG and normal saline group (NS) according to the random number table, with 30 rats in each group. Perforator flap with three angiosomes was made on the right dorsal side of rat, including deep iliac circumflex artery perforator, intercostal artery perforator, thoracodorsal artery perforator, as well as CZ 1 and CZ 2...
July 20, 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Heng Xu, Zheng Zhang, Yimeng Xia, Zvi Steinberger, Peiru Min, Hua Li, Yahui Dai, Yixin Zhang
Background The best known limitation to the use of prefabricated flaps is their limited survival area. One explanation for this is insufficient neovascularization. However, blood flow of prefabricated flaps is through their innate vascular network. This could lead one to conclude that angiosomes may impede blood perfusion. This study aims to settle this contradiction between theory and clinical practice. Methods We performed a two-stage operation of a prefabricated abdominal flap in a rat model. The rats were divided into five groups (n = 6/group)...
July 25, 2016: Journal of Reconstructive Microsurgery
Kum Ju Chae, Jin Yong Shin
PURPOSE: Given that the efficacy of employing angiosome-targeted angioplasty in the treatment of diabetic foot remains controversial, this study was conducted to examine its efficacy. METHODS: We performed a systematic literature review and meta-analysis using core databases, extracting the treatment modality of angiosome-targeted angioplasty as the predictor variable, and limb salvage, wound healing, and revision rate as the outcome variables. We used the Newcastle-Ottawa Scale to assess the study quality, along with the Cochrane Risk of Bias Tool...
2016: PloS One
Marie Pavé, Laurent Benadiba, Ludovic Berger, Djeloul Gouicem, Maxime Hendricks, Didier Plissonnier
PURPOSE: To evaluate the long-term clinical results of Below-the-Knee Percutaneous Transluminal Angioplasty (BTK-PTA) with or without stenting, in patients with Critical Limb Ischemia (CLI), and to determine factors affecting clinical results including the role of the angiosome concept. METHODS: All patients undergoing primary BTK-PTA from January 2007 to December 2011 were included. Primary patency, assisted patency, limb salvage, survival and wound healing were assessed using the Kaplan-Meier method...
July 14, 2016: Annals of Vascular Surgery
Kyle J Cooper, Constantino Peña, James Benenati
Critical limb ischemia is a condition that has increased in prevalence and carries a high degree of morbidity. Although endovascular therapy for treatment of patients with critical limb ischemia has undergone significant advances with improved outcomes over the past decade, these patients often have multilevel disease, and it may take weeks or months for ulceration healing. For this reason, the acceptable therapeutic end points during and immediately following revascularization remain somewhat obscure. There are multiple tools available to guide the treating vascular specialist in this regard...
June 2016: Techniques in Vascular and Interventional Radiology
Gudjon Leifur Gunnarsson, Troels Tei, Jørn Bo Thomsen
Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps...
October 2016: Annals of Plastic Surgery
Gökhan Temiz, Nebil Yeşiloğlu, Hakan Şirinoğlu, Ali Cem Akpınar, Murat Sarıcı, Deniz Filinte, Gaye Taylan Filinte, Mehmet Bozkurt
BACKGROUND: Botulinum toxin type-A (Bot-A) is a commonly used drug for both cosmetic and therapeutic purposes. The effects of Bot-A on skin and muscle flaps and the related mechanisms have been described previously. In this study, we used a rat transverse rectus abdominis musculocutaneous (TRAM) flap model to examine the effects of Bot-A on the skin island, which is perfused by the rectus abdominis muscle according to the angiosome concept. METHODS: Forty female rats were divided into five groups, including control and sham groups...
July 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Jie Zheng, David Muccigrosso, Xiaodong Zhang, Hongyu An, Andrew R Coggan, Bashir Adil, Charles F Hildebolt, Chandu Vemuri, Patrick Geraghty, Mary K Hastings, Michael J Mueller
PURPOSE: To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. MATERIALS AND METHODS: In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method...
October 2016: Journal of Magnetic Resonance Imaging: JMRI
Ehrin J Armstrong, Kalkidan Bishu, Stephen W Waldo
Endovascular treatment of infrapopliteal disease is focused on the treatment of patients with rest pain or critical limb ischemia (CLI) due to severe atherosclerotic disease. While the evidence base surrounding the comparative effectiveness of endovascular intervention vs. surgery is lacking, many operators have adopted an "endovascular first" approach to the treatment of infrapopliteal atherosclerotic disease due to the lower morbidity of these procedures. This manuscript reviews current data on the endovascular treatment of CLI, including a comparison of endovascular and surgical approaches, current indications for and outcomes with balloon angioplasty of infrapopliteal PAD, angiosome-guided revascularization, and emerging technologies to improve long-term vessel patency after endovascular intervention...
April 2016: Current Cardiology Reports
Scott Kinlay
Critical limb ischemia (CLI) is a clinical syndrome of ischemic pain at rest or tissue loss, such as nonhealing ulcers or gangrene, related to peripheral artery disease. CLI has a high short-term risk of limb loss and cardiovascular events. Noninvasive or invasive angiography help determine the feasibility and approach to arterial revascularization. An endovascular-first approach is often advocated based on a lower procedural risk; however, specific patterns of disease may be best treated by open surgical revascularization...
February 2016: Circulation. Cardiovascular Interventions
Rafael de Athayde Soares, Francisco Cardoso Brochado Neto, Marcelo Fernando Matielo, Carlos Neutzling Lehn, Edson Takamitsu Nakamura, Marcos Roberto Godoy, Marcus Vinícius Martins Cury, Maysa Heineck Cury, Roberto Sacilotto
BACKGROUND: The purpose of this study was to evaluate the importance of the "angiosome" concept in patients with critical limb ischemia treated with infrapopliteal angioplasty, analyzing limb salvage, secondary function, and survival rates between those treated with and without reference to the concept of the angiosome (groups 1 and 2, respectively). METHODS: This was a retrospective, consecutive cohort study that evaluated 95 patients with critical limb ischemia who underwent infrapopliteal angioplasty at the Division of Vascular and Endovascular Surgery, São Paulo State Public Servants' Hospital, Brazil, between January 2009 and January 2013...
April 2016: Annals of Vascular Surgery
Xiang-Tao Zheng, Rui-Chao Zeng, Jing-Yong Huang, Le-Men Pan, Xiang Su, Zi-Heng Wu, Guan-Feng Yu
BACKGROUND: The purpose of this study was to evaluate the clinical significance of the involvement of collateral vessels in interventional therapy based on the angiosome concept for infrapopliteal critical limb ischemia (CLI). METHODS: We enrolled 486 patients with unilateral infrapopliteal CLI (Rutherford Stage 5 or 6) treated at 2 hospitals from January 2005 to December 2014. Using the angiosome concept, the patients were categorized into 3 groups: the direct revascularization (DR) group, the indirect revascularization through collaterals (IR-tc) group, and the indirect revascularization without collaterals (IR-wc) group...
April 2016: Annals of Vascular Surgery
Manuel J Pellegrini, Adam P Schiff, Samuel B Adams, James K DeOrio, Mark E Easley, James A Nunley
BACKGROUND: A number of operative approaches have been described to perform a tibiotalocalcaneal (TTC) arthrodesis. Here we present the largest reported series of a posterior Achilles tendon-splitting approach for TTC fusion. METHODS: With institutional review board approval, a retrospective review of the TTC fusions performed at a single academic institution was carried out. Orthopedic surgeons specializing in foot and ankle surgery performed all procedures. Eligible patients included all those who underwent a TTC fusion via a posterior approach and had at least a 2-year follow-up...
March 2016: Foot & Ankle International
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