Role of Arteriogenesis Mechanism in the Remodeling of Choke Vessels in Delayed Multiterritory Perforator Flaps: A...

The aim of this study is to elucidate the role of the arteriogenesis mechanism and its impact on the remodeling of choke vessels within the delayed multiterritory perforator flap (MPF) from the perspective of protein molecular mechanisms.

Integument radiography and HE staining were used to conduct qualitative and quantitative evaluations of the microvascular morphology within the choke zones. A laser Doppler blood flow imager was used to assess blood perfusion. Immunohistochemistry was used to perform qualitative, semiquantitative, and localized analyses of the spatiotemporal dynamic expression of protein molecules involved in collateral artery growth within the choke zone at 1, 3, 5, and 7 days following delayed surgery and flap elevation.

Radiographs of the perfused integuments revealed that true anastomoses emerged in choke zones 1 and 2 three days after the delayed surgery. HE staining findings showed that after flap delay surgery, both choke zones 1 and 2 underwent remodeling, characterized by increased arteriolar diameters and decreased microvessel density. The blood perfusion units in choke zones 1 and 2 were significantly higher on 1 day than at 4 hours after the delayed surgery (P<0.05). In choke zones 1 and 2, protein molecules associated with collateral artery remodeling-including TRPV4, VE-cadherin, eNOS, iNOS, ICAM-1, FAK, Ephrin B2, PLGF, CD163, MMP-9, MMP-2, and CX-37-exhibited significant increases after delayed surgery and/or flap elevation, compared with their preoperative expression levels (P<0.05).

The spatiotemporal dynamic changes of protein molecules related to the remodeling of collateral arteries are closely related to the remodeling of choke vessels in choke zones 1 and 2 of delayed MPF with ligated perforators in the dynamic region, and the arteriogenesis mechanism may play an important role in the remodeling of these choke vessels.