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The Functional Angiosome: Clinical Implications of the Anatomical Concept

Taylor, G. Ian, A.O., F.R.A.C.S.; Corlett, Russell J., F.R.A.C.S.; Ashton, Mark W., F.R.A.C.S.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 721-733
doi: 10.1097/PRS.0000000000003694
Experimental: Original Articles
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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.

Parkville, Victoria, Australia

From the Taylor Lab, Department of Anatomy and Neuroscience, and the Royal Melbourne Hospital Department of Surgery, University of Melbourne.

Received for publication February 21, 2017; accepted May 17, 2017.

Presented at the 17th International Course on Perforator Flaps, in Sydney, New South Wales, Australia, November 10 through 13, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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G. Ian Taylor, A.O., F.R.A.C.S., Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria 3052, Australia, g.taylor@unimelb.edu.au

Copyright © 2017 by the American Society of Plastic Surgeons