Arteriogenesis mechanism of choke vessel remodelling in multiterritory perforator flap in rats

Ping Peng; Zhonggen Dong; Zhaobiao Luo; Jianwei Wei; Lingli Zhou

doi:10.1016/j.bjps.2025.06.037

Arteriogenesis mechanism of choke vessel remodelling in multiterritory perforator flap in rats

J Plast Reconstr Aesthet Surg. 2025 Jul 7:107:184-191. doi: 10.1016/j.bjps.2025.06.037. Online ahead of print.

Authors

Ping Peng¹, Zhonggen Dong², Zhaobiao Luo³, Jianwei Wei⁴, Lingli Zhou⁵

Affiliations

¹ Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha 410013, Hunan, People's Republic of China.
² Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha 410011, Hunan, People's Republic of China.
³ Department of Orthopedics, Changsha Central Hospital, Changsha 410028, Hunan, People's Republic of China.
⁴ Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha 410011, Hunan, People's Republic of China. Electronic address: doctorway@csu.edu.cn.
⁵ Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China. Electronic address: doctorway@csu.edu.cn.

PMID: 40651425
DOI: 10.1016/j.bjps.2025.06.037

Abstract

Background: The remodelling of choke vessels within the multiterritory perforator flap (MPF) is intricately associated with the blood supply of the flap. The objective of this study was to elucidate the revascularization mechanism underlying the remodelling of these choke vessels.

Methods: Integument radiography and hematoxylin-eosin (HE) staining were utilised to qualitatively and quantitatively evaluate the microvascular morphology within the choke zones. The Evans blue dye was employed to quantify blood flow velocities in the choke arteries within choke zone I, while a laser Doppler blood flow imager was utilised to assess blood perfusion. Immunohistochemistry was also conducted to evaluate the expression of proteins associated with arteriogenesis mechanisms.

Results: In choke zone I, several true anastomotic arteries were observed in the 3d postoperation (PO) group. There was no significant increase in arteriolar density; however, the maximum calibre of arterioles in the 3 d, 5 d, and 7 d PO groups exceeded that of the control group (P<0.05). HE staining showed a decrease in microvessel density and dilation of the microvasculature. The arterial blood flow velocity began to significantly increase at 6 h PO (P<0.05) and reached its peak at 1 d PO. Blood perfusion was higher at 1 d PO than at 6 h PO (P<0.05). The expression of the TRPV4, Ephrin B2, CD11b, MMP-9 and eNOS increased significantly (P<0.05).

Conclusions: Arteriogenesis is likely the key revascularization mechanism involved in choke artery remodelling in choke zone I. Arteriogenesis and angiogenesis play similar roles in choke artery remodelling in choke zone II.

Keywords: Arteriogenesis; Choke vessel; Perforator flap; Revascularization; Surgical flap.