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Mathematics taking guesswork out of plastic surgery tissue transfer
Date:7/14/2009

ons apart; the rate of exchange of oxygen from vessels to tissue; and the pressure under which the blood is flowing in those vessels.

"The fact that there are thousands of capillaries makes it difficult to compute the oxygen levels, so we found a method of averaging. We average the oxygen concentration in the capillaries, think of capillaries as being uniformly spread all over, and look at the transport of oxygen from vessels into tissue," Friedman said.

The model's outcomes exploited clinical observations, in that if the oxygen pressure fell below 15 percent during the few days following the tissue transfer, fat tissue on the outer edges of the flap would start to die. When that happens on actual surgical cases, doctors must replace the dead tissue, and sometimes have to redo the entire operation.

More work lies ahead to make the model truly useful in a surgical setting, Miller and Friedman agreed.

In live human tissue, the pattern of blood vessels and capillaries is not uniformly spread throughout the flap. In many cases, there is a gap in the presence of branching vessels at the point at which the feeder artery and vein enter the fat and divide.

And to add accuracy to the parameters used in the equations, the researchers agree that animal studies of tissue transfer are needed to make the model more reliable.

Imaging technology is also expected to factor into the future of reconstructive surgery. Surgeons currently use three-dimensional CT scans to image a potential flap and the perforator vessels that are feeding that flap. But the imaging available to date can't display the entire vasculature of a flap.

Friedman said he and colleagues hope to provide surgeons with software that could be combined with advanced imaging to supply more reliable information about the likely survival of a tissue flap.

"The surgeon will take an image of a flap that will give an idea of the distribution of vessel
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Contact: Michael Miller
michael.miller@osumc.edu
614-293-8566
Ohio State University
Source:Eurekalert

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