- Email: [email protected]
“Angiosome theory”—reply
British Journal
328
References Buchanan, R. T. and Levine, N. S. (1982).Blood pressure drop as a result of Fluorescein injection. Plastic and Reconstructive Surgery, 70, 363. Callegari, P., Taylor, G. I., Caddy, C. M, and Minebe, T. (1992). An
anatomical review of the delay phenomenon : Part I experimental work. Plastic and Reconstructive Surgery, 89, (in press). Pang, C. Y., Neligan, P., Nakatsuka,
T. and Sasaki,
G. H. (1986).
Assessment of the Fluorescein dye test for prediction of skin flap viability in pigs. Journal of Surgical Research, 41, 173. Taylor, G. I. and Palmer, J. H. (1987). The vascular territories (angiosomes) of the body: experimental study and clinical applications. British Journal of Plastic Surgery, 40, 113. Taylor, G. I. and Minabe, T. (1992). The angiosomes of mammals and other vertebrates. Plastic and Reconstructive Surgery, 89, (in press). Taylor, G. I., Corlett, R. J., Caddy, C. M. and Zelt, R. G. (1992). An anatomical review of the delay phenomenon: Part II, clinical applications. Plastic and Reconstructive Surgery, 89, (in press). Thomson, J. G. and Kerrigan, C. L. (1989). Dermofluorometry: thresholds for predicting flap survival. Plastic and Reconstructive Surgery, 83, 859.
“Angiosome
theory”-reply
Sir, The fact that I undertook this investigation (British Journal of Plastic Surgery, 45,2 19) indicates that I had reservations
about the validity of the entire angiosome concept. This was not based on any misconception or misunderstanding. I found it difficult to reconcile, for example, the similarity of the dye distribution via the thoracodorsal and circumflex scapular arteries seen in Figures 1E and F in Taylor and Palmer’s (1987) paper. The absence of an angiosome supplied by the superficial circumflex iliac artery, the basis of the groin flap, was equally difficult to understand. In conceding that “the physiological dynamic territory of an artery may expand (or retract) from or within its anatomical territory depending on the physiological (or pathological) circumstances”, Taylor and Palmer have introduced physiological arguments which fatally undermine their anatomical concept. The main thrust of their comments differs little from my own - blood flow in vivo varies because the watershed between vascular territories is labile (not static) and cannot. therefore, be predicted. In view of this, and the fact that virtually all arteries exhibit the choke phenomenon (being narrower distally than proximally in the direction of flow), it would be wiser,
perhaps, to abandon cepts.
of Plastic Surgery
both the choke and angiosome con-
Yours faithfully, Alan D. McGregor, MD, FRCS (G), FRCS (Plast Surg), Consultant Plastic Surgeon, St Lawrence Hospital, Chepstow, Gwent NP6 5YX, UK References A. D. (1992). The angiosome -an in vivo study by fluorescein angiography. British Journal of Plastic Surgery, 45,
McGregor, 219. Taylor,
G. I. and Palmer, J. H. (1987). The vascular territories (angiosomes) of the body: an experimental study and clinical implications. British Journal of Plastic Surgery, 40, I 13.
Breast implant seroma in pregnancy Sir, I am writing in regard to Mr Cormack’s letter about breast implant seroma in pregnancy (British Journal of Plastic Surgery, 44, 628). I also had 2 patients
with breast implants who developed seromas during pregnancy. One was a 27-year-old who had a submuscular augmentation in 1987. In 1989, when 4 months pregnant, she presented with a seroma from which 380 c.c.‘s were drained via percutaneous metal cannula. Cultures were negative. Some residual fluid remained (perhaps 100 c.c.‘s), but was left in place. The fluid had resolved when 6 weeks postpartum, but she then developed a scar contracture requiring an open capsulectomy. The other was a 33-year-old who had a subglandular augmentation in February 1990. In August 1990, when 5 months pregnant, she presented with a seroma of the left breast from which 750 c.c.‘s were drained. Again, some residual fluid (perhaps lo&200 c.c.‘s) remained, which resolved post partum. Again a contracture developed. Yours faithfully, W. L. Wuest, MD, PA, 333 No. Rivershire, Suite 240, Conroe, Texas 77304, USA.
328
References Buchanan, R. T. and Levine, N. S. (1982).Blood pressure drop as a result of Fluorescein injection. Plastic and Reconstructive Surgery, 70, 363. Callegari, P., Taylor, G. I., Caddy, C. M, and Minebe, T. (1992). An
anatomical review of the delay phenomenon : Part I experimental work. Plastic and Reconstructive Surgery, 89, (in press). Pang, C. Y., Neligan, P., Nakatsuka,
T. and Sasaki,
G. H. (1986).
Assessment of the Fluorescein dye test for prediction of skin flap viability in pigs. Journal of Surgical Research, 41, 173. Taylor, G. I. and Palmer, J. H. (1987). The vascular territories (angiosomes) of the body: experimental study and clinical applications. British Journal of Plastic Surgery, 40, 113. Taylor, G. I. and Minabe, T. (1992). The angiosomes of mammals and other vertebrates. Plastic and Reconstructive Surgery, 89, (in press). Taylor, G. I., Corlett, R. J., Caddy, C. M. and Zelt, R. G. (1992). An anatomical review of the delay phenomenon: Part II, clinical applications. Plastic and Reconstructive Surgery, 89, (in press). Thomson, J. G. and Kerrigan, C. L. (1989). Dermofluorometry: thresholds for predicting flap survival. Plastic and Reconstructive Surgery, 83, 859.
“Angiosome
theory”-reply
Sir, The fact that I undertook this investigation (British Journal of Plastic Surgery, 45,2 19) indicates that I had reservations
about the validity of the entire angiosome concept. This was not based on any misconception or misunderstanding. I found it difficult to reconcile, for example, the similarity of the dye distribution via the thoracodorsal and circumflex scapular arteries seen in Figures 1E and F in Taylor and Palmer’s (1987) paper. The absence of an angiosome supplied by the superficial circumflex iliac artery, the basis of the groin flap, was equally difficult to understand. In conceding that “the physiological dynamic territory of an artery may expand (or retract) from or within its anatomical territory depending on the physiological (or pathological) circumstances”, Taylor and Palmer have introduced physiological arguments which fatally undermine their anatomical concept. The main thrust of their comments differs little from my own - blood flow in vivo varies because the watershed between vascular territories is labile (not static) and cannot. therefore, be predicted. In view of this, and the fact that virtually all arteries exhibit the choke phenomenon (being narrower distally than proximally in the direction of flow), it would be wiser,
perhaps, to abandon cepts.
of Plastic Surgery
both the choke and angiosome con-
Yours faithfully, Alan D. McGregor, MD, FRCS (G), FRCS (Plast Surg), Consultant Plastic Surgeon, St Lawrence Hospital, Chepstow, Gwent NP6 5YX, UK References A. D. (1992). The angiosome -an in vivo study by fluorescein angiography. British Journal of Plastic Surgery, 45,
McGregor, 219. Taylor,
G. I. and Palmer, J. H. (1987). The vascular territories (angiosomes) of the body: an experimental study and clinical implications. British Journal of Plastic Surgery, 40, I 13.
Breast implant seroma in pregnancy Sir, I am writing in regard to Mr Cormack’s letter about breast implant seroma in pregnancy (British Journal of Plastic Surgery, 44, 628). I also had 2 patients
with breast implants who developed seromas during pregnancy. One was a 27-year-old who had a submuscular augmentation in 1987. In 1989, when 4 months pregnant, she presented with a seroma from which 380 c.c.‘s were drained via percutaneous metal cannula. Cultures were negative. Some residual fluid remained (perhaps 100 c.c.‘s), but was left in place. The fluid had resolved when 6 weeks postpartum, but she then developed a scar contracture requiring an open capsulectomy. The other was a 33-year-old who had a subglandular augmentation in February 1990. In August 1990, when 5 months pregnant, she presented with a seroma of the left breast from which 750 c.c.‘s were drained. Again, some residual fluid (perhaps lo&200 c.c.‘s) remained, which resolved post partum. Again a contracture developed. Yours faithfully, W. L. Wuest, MD, PA, 333 No. Rivershire, Suite 240, Conroe, Texas 77304, USA.