Taylor GI, Corlett RJ, Ashton MW, et al.
Plastic and reconstructive surgery. Date of publication 2017 Oct 1;volume 140(4):721-733.
1. Plast Reconstr Surg. 2017 Oct;140(4):721-733. doi: 10.1097/PRS.0000000000003694.
The Functional Angiosome: Clinical Implications of the Anatomical Concept.
Taylor GI(1)(2), Corlett RJ(1)(2), Ashton MW(1)(2).
Author information:
(1)Parkville, Victoria, Australia.
(2)From the Taylor Lab, Department of Anatomy and Neuroscience, and the Royal
Melbourne Hospital Department of Surgery, University of Melbourne.
BACKGROUND: The angiosome is a three-dimensional block of tissue supplied by a
source vessel with its boundary outlined either by an anastomotic perimeter of
reduced-caliber choke vessels or by true anastomoses with no reduction of vessel
caliber. This article focuses on the role of these anastomotic vessels in
defining flap survival or the necrotic pattern seen in fulminating meningococcal
septicemia.
METHODS: Experiments in pigs, dogs, guinea pigs, and rabbits over the past 46
years were reviewed, focusing on the necrosis line of flaps, the effects of
various toxins in vivo, and correlating these results in the clinical setting.
RESULTS: Experimentally, choke anastomoses are functional and control flow
between perforator angiosomes. They (1) permit capture of an adjacent angiosome
when the flap is raised on a cutaneous perforator in 100 percent of cases, with
the necrosis line occurring usually in the next interperforator connection; (2)
confine flow to the territory of the involved artery when a toxin is introduced
by spasm around its perimeter; and (3) lose this property of spasm when choke
vessels are converted to true anastomoses following surgical delay, or where true
anastomoses occur naturally, thereby allowing unimpeded blood flow and capture of
additional angiosome territories. Clinical experience supports these
observations.
CONCLUSIONS: The functional angiosome is the volume of tissue that clinically can
be isolated on a source vessel. The area extends beyond its anatomical territory
to capture an adjacent territory if connections are by choke anastomoses, or more
if they are by true anastomoses.
DOI: 10.1097/PRS.0000000000003694
PMID: 28953725 [Indexed for MEDLINE]
