Blood splatter banner effect7/14/2023 ![]() Therefore, pre-intervention methods for flap transplantation are frequently conducted to reduce the resistance of the choke area, promote the transition from choke anastomosis to the true anastomosis, and eventually increase the blood perfusion and survival area of the flap. Hence, if the choke anastomoses between adjacent perforator arteries could be converted into true vascular anastomoses, the area of the donor graft would be greatly increased. This ischemia is more severe when the adjacent perforating arteries are the choke connection 9, 10, 11. The skin arteries only have a limited blood supply range thus, skin area beyond the working range of an artery in the grafted skin flaps will have insufficient blood supply. The survival area of grafted skin flaps is directly determined by sufficient blood perfusion, patency of the main axial anastomosis artery, and microcirculation in the transplanted tissue during the perioperative period 7, 8. These undesirable consequences result in an increased number of repeatedly surgeries for patients, coupled with extended hospital stay duration, and a substantial burden on family, social, health, and economic routine patient care. Autologous free flap transplantation is the primary method of reconstructive surgery used to repair such defects 1, however, similar to other organ transplants, free flap transplants often suffer from common complications such as sufficient blood perfusion, tissue microcirculation disturbance, early ischemia-reperfusion injury (IRI), insufficient donor area, distal ischemic necrosis, etc 2, 3, 4, 5, 6. Skin, muscle, fat, nerve, and other complex soft tissue defects could arise from tumor resection, trauma, and congenital malformations, thus leading to tissue atrophy and dysfunction. We demonstrate that the hydrogel patch promotes distal vascularization and long-term functional reconstruction of transplanted tissues by inhibiting inflammatory damage and accelerating blood vessel formation. Using an ischemia-reperfusion dorsal skin flap model in rats, we show that the hydrogel patch maintains the immediate opening of blood flow channels in transplanted tissue and effective blood perfusion throughout the perioperative period, activating perfusion of the hemodynamic donor site. To address this issue, we develop a hydrogel patch that releases carbon monoxide and nitric oxide gases on demand, to afford a timely blood supply for skin flap transplantation during surgery. Limited blood supply range and post-transplantation ischemia-reperfusion injury can lead to distal necrosis of the flap and long-term functional loss, which severely restricts the decision-making regarding the optimal surgical plan. Autologous skin flap transplantation is a common method for repairing complex soft tissue defects caused by cancer, trauma, and congenital malformations.
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