The technique of vascular delay has been used by plastic surgeons for nearly 500 years and has proven useful for reliably transferring tissue and allowing for a greater volume of tissue to be reliably harvested. Delay procedures are an essential plastic surgical tool for a variety of aesthetic and reconstructive procedures. Despite the widespread use of vascular delay procedures, the mechanism by which this phenomenon occurs remains unclear. A number of groups have exhaustively examined microvascular changes that occur during vascular delay. Theories have been proposed ranging from the dilation of choke vessels to changes in metabolism and new blood vessel formation. Inherent in these theories is the concept that ischemia is able to act as the primary stimulus for vascular changes. The purpose of this review is to revisit the theories proposed to underlie the delay phenomenon in light of recent advances in vascular biology. In particular, the participation of bone marrow–derived endothelial progenitor cells in the delay phenomenon is explored. Greater understanding of the role these cells play in new blood vessel formation will be of considerable clinical benefit to high-risk patients in future applications of delay procedures.
London, United Kingdom; New York, N.Y.; and Stanford, Calif.
From the Department of Plastic Surgery, Royal Free Hospital, University of London; Laboratory of Microvascular Research and Vascular Tissue Engineering, Institute of Reconstructive Plastic Surgery, New York University Medical Center; and Division of Plastic Surgery, Stanford University School of Medicine.
Received for publication August 26, 2005; accepted October 21, 2005.
Winner of the 2003 Research Council Peter J. Gingrass Award and the 2004 Plastic Surgery Educational Foundation Bernard G. Sarnat Award to O.M.T.
Oren M. Tepper, M.D., Institute of Reconstructive Plastic Surgery, 560 First Avenue, TH-169, New York, N.Y. 10016, firstname.lastname@example.org