title: The effect of hemodynamic remodeling on the survival of arterialized venous flaps.
abstract: OBJECTIVE
  To evaluate the effect of hemodynamic remodeling on the survival status of the arterialized venous flaps (AVFs) and investigate the mechanism of this procedure.
  
  
  METHODS
  Two 7 x 9 cm skin flaps in each rabbit (n=36) were designed symmetrically in the abdomen. The thoracoepigastric pedicle and one femoral artery were used as vascular sources. Four groups were included: Composite skin grafts group and arterial perfusion group were designed in one rabbit; AVF group and hemodynamic remodeling group by ligation of the thoracoepigastric vein in the middle were outlined in another rabbit. Flap viability, status of vascular perfusion and microvasculature, levels of epidermal metabolite and water content in each group were assessed.
  
  
  RESULTS
  Highly congested veins and simple trunk veins were found using angiography in the AVF group; while a fairly uniform staining and plenty of small vessels were observed in the hemodynamic remodeling group. The metabolite levels of the remodeling group are comparable with those in the arterial perfusion group. There was no statistically significant difference in the percentage of flap survival between the arterial perfusion group and hemodynamic remodeling group; however, significant difference was seen between the AVF group and the hemodynamic remodeling group.
  
  
  CONCLUSIONS
  Under the integrated perfusion mode, the AVFs are in an over-perfusion and non-physiological hemodynamic state, resulting in unreliability and unpredictability in flap survival; under the separated perfusion mode produced by remodeling, a physiological-like circulation will be created and therefore, better flap survival can be expected.
authors.affiliation: Department of Orthopedics, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China ; Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
authors.forename: Hede
authors.initials: H
authors.lastname: Yan
authors.forename: Jon
authors.initials: J
authors.lastname: Kolkin
authors.forename: Bin
authors.initials: B
authors.lastname: Zhao
authors.forename: Zhefeng
authors.initials: Z
authors.lastname: Li
authors.forename: Shichao
authors.initials: S
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Xia
authors.forename: Cunyi
authors.initials: C
authors.lastname: Fan
mesh_terms: D000818:Animals; D023381:Endpoint Determination; D004817:Epidermis / Q000378:metabolism / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D006439:Hemodynamics; D008297:Male; D011817:Rabbits; D013524:Surgical Flaps / Q000098:blood supply*; D014680:Veins / Q000502:physiology*; D014867:Water / Q000378:metabolism
chemical_list: D014867:Water