Since the cremaster muscle flap is an isolated axial pattern flap in which all collateral vessels are transected, it is the ideal model to study the effects of muscle denervation including influence of neurogenic factors on the microcirculatory response. Applying this model it is also possible to test the microvascular response to the topical application of the vasoactive substances. In such scenarios the cremaster muscle flap can be applied as an acute or as a chronic model.
1. Technique—acute model. After cremaster muscle flap dissection on the neurovascular pedicle, the denervation procedure is performed by resecting a 1-cm segment of the genitofemoral nerve in the groin area leading to flap sympathectomy. Next, the adventitia of both the iliac and femoral artery and vein are excised circumferentially just above and below the pudic-epigastric pedicle resulting in somatic denervation of the flap. The flap is then prepared for microcirculatory evaluation.
2. Technique—chronic models. We have developed chronic models for long-term microcirculatory recordings. The cremaster muscle tube flap could be modified by the two-stage denervation procedure. In the first stage an incision is made in the groin, and the iliac and femoral vessels and genitofemoral nerve are exposed. Next, the standard den-ervation procedure of 1 cm of nerve segment resection and excision of the femoral artery and vein adventitia is performed. The flap denervation can be carried out from 24 hours up to 14 days. At this point the second-stage procedure of standard surgical dissection of the cremaster muscle flap on the tissue bath is performed and micro-circulatory measurements revealing the effects of flap denervation are recorded. As a result of these observations a triphasic sequence was observed, starting with (1) an acute hyperadrenergic phase, followed by (2) a non-adrenergic phase (vasodilatation) and (3) a sensitized phase where increased capillary perfusion and hyper-responsiveness to vasoactive substances was observed. Based on these observations it was evident that microcirculation can be significantly improved by muscle sympathectomy and somatic denervation .
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