title: Revascularization of Arterialized Venous Flaps through a Total Retrograde Reverse Blood Flow: Randomized Experimental Trial of Viability.
abstract: BACKGROUND
  Arterialized venous flaps (AVFs) have been used for reconstruction of soft tissue defects throughout the body. Several different revascularization models have been performed, but venous drainage through the arterial system has not been studied. In our total retrograde reverse blood flow (TRRBF) perfusion model, the arterial blood flow enters through the venous system and venous drainage exits through the arterial system.
  
  
  METHODS
  We developed a novel experimental model in rabbit ears to evaluate the capacity of TRRBF perfusion pattern to allow AVF viability. The ears were assigned to 3 groups: group 1, total devascularization without revascularization (n = 3); group 2, TRRBF (n = 12); and group 3, conventional AVF (n = 12). The ears were observed during a 30-day follow-up period, and clinical serial assessment of edema, cyanosis, and necrosis was performed. Tissue oxygenation was determined at the beginning and end of the follow-up. Histological analysis was performed.
  
  
  RESULTS
  Necrosis was found in 3/3 (100%) ears in group 1, 3/12 (25%) in group 2, and 0/12 (0%) in group 3 (95% CI, 0.505-0.994; P = 0.0001). In group 2, edema was higher (5/12, 41.66%) than in group 3 (0/12, 0%) (95% CI, 0.0135-0.65; P = 0.041). Cyanosis and venous congestion was of greater intensity and duration in group 2 than in group 3 (10.33 ± 4.51 vs 4.5 ± 2.06 d).
  
  
  CONCLUSIONS
  Although evolution is torpid and prolonged in ears with TRRBF, 9/12 (75%) survived, suggesting that TRRBF can be used as a rescue method.
authors.affiliation: Service of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico; and Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
authors.forename: Martín
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Service of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico; and Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
authors.forename: José A
authors.initials: JA
authors.lastname: Fonseca-Lazcano
authors.affiliation: Service of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico; and Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
authors.forename: Mario Arturo R
authors.initials: MA
authors.lastname: Moran
authors.affiliation: Service of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico; and Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Butron
authors.affiliation: Service of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico; and Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico.
authors.forename: Melina
authors.initials: M
authors.lastname: Díaz-Morales