BACKGROUND: After years of development, a variety of flaps are now available in clinic for defect reconstruction. But problems exist that when a large flap is harvested, a varying degree of necrosis often occurs. In order to solve this problem, researchers and clinicians focus on study of two main pathways for neovascularization: angiogenesis and vasculogenesis, with the hope that deeper research in neovascularization can be manipulated to improve flap survival and culture of engineering vessels.
OBJECTIVE: To provide a comprehensive review on three aspects: the microvascular physiology, the neovascularization after ischemia and injury, and tissue engineering related to defect reconstruction. To summarize the progression of vascular biology research and its using prospect.
METHODS: The first author retrieved literatures from PubMed database with the index words of “flap, reconstructive surgery, vascular physiology, choke vessels, angiogenesis, vasculogenesis, tissue engineering” in English. After reading and analysis of the literature of interest, the flap development history and survival mechanism, the patterns of neovascularization, and its regulating mechanism at the molecular level, and the role of neovascularization in tissue engineering were summarized and presented in this article. A total of 69 articles were retrieved, and after screening according to the inclusion and exclusion criteria, 30 articles were elaborately studied and the viewpoints extracted.
RESULTS AND CONCLUSION: The results showed that necrosis of the flap often occurs at the choke zone, and neovascularization whose two main pathways were angiogenesis and vasculogenesis showed great importance to flap survival. Scaffolds design and cell sources were two vital problems for development of tissue engineering aimed for defect reconstruction. Now, how to manipulate the neovascularization at the molecular level to improve flap survival and culture vascularized engineering tissue in a more efficient way was still a huge field yet to be explored.