“A Law of Flap Survival Area Based on the Angiosome Concept”

Abstract

 In the angiosome concept advocated by Taylor et al. in 1987, the vasculature of the surgical flap is expressed by the number of anatomical territories (angiosomes) contained in the flap, such as ‘2-territory flap’ or ‘3-territory flap’. When the flap is raised, the choke vessels between the first and second vascular territories dilate and transform to the true anastomoses that can make a new larger territory by combination of the first and second territories. However, the third vascular territory is commonly not involved, because the choke vessels between the second and third territories will not fully dilate. “Opening of the first choke zone and capturing of the second vascular territory with safety” is supported by our series of experiments using flaps with various numbers and alignment of the vascular territories and vascular pedicles. Considering this law of flap survival, we can more safely design flaps with fairly accurate estimation of the expected survival area of the flap.