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Cutaneous perforator mapping and ink-based perfusion assessment in an ovine model: An anatomical study and systematic
Ugo Lancien1,2,3, Léa Passemard2,3, François Thuau1,2,3
1Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France.
Background:
A precise understanding of perforator anatomy and the corresponding cutaneous perfusion is essential for the design of perforator flaps in reconstructive surgery. Although large-animal models such as the sheep more closely reproduce human vascular dimensions than rodents, data integrating systematic anatomical mapping with functional perfusion assessment in this model are scarce.
Methods:
A systematic review (PRISMA 2020) was conducted in PubMed, Cochrane Central and Scopus to identify ovine studies investigating perforator anatomy and/or vascular injection techniques. Methodological quality was assessed with the MINORS tool. In parallel, an anatomical study was performed on seven adult ewes (Ovis aries). Five vessels were dissected on each side (10 vessels per animal, 70 perforators in total): the deep circumflex iliac (DCI), medial tarsal (MT), cranial tibial (CT), superior epigastric (SE) and thoracodorsal (TD). Perforator coordinates were recorded using a standardized orthogonal reference system based on reproducible anatomical landmarks. Pedicle length and vessel diameter were measured. A reproducible India-ink injection protocol was used to map the cutaneous territory perfused by each pedicle, quantified by digital planimetry (ImageJ).
Results:
The systematic review yielded eight heterogeneous studies, none of which combined perforator mapping with India-ink-based perfusion assessment in a sheep model (mean MINORS score 11.25 ± 3.01). The anatomical study identified five reproducible dominant pedicles with consistent spatial organization. Mean pedicle lengths ranged from 7.25 ± 1.57 cm (SE) to 17.43 ± 2.23 cm (TD). Mean perfused cutaneous areas ranged from 188 ± 36 cm² (CT) to 650 ± 84 cm² (DCI).
Conclusion:
This study provides the first combined anatomical and functional characterization of cutaneous perforators in the ovine model. The standardized mapping framework, quantitative vascular measurements and reproducible India-ink perfusion protocol provide a reproducible experimental framework for experimental research in perforator flap surgery and microsurgical training.
