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Authors: Rami Mossad Ibrahim, Magnus Obinah, Magnus Balslev Avnstorp MD, Peter Stemann, Birgitte Jul Kiil and Christian Kaare Paaskesen Med. Stud.

Angiosomes are three-dimensional territories from bone to skin, supplied by named arteries travelling with veins and nerves in a neurovascular bundle. Angiosomes consist of arteriosomes (the arterial blood supply) and venosomes (the venous drainage) that are connected for optimal blood circulation.

In the dermal and subdermal tissues, angiosomes are connected either by vessels with a reduced-caliber arteries called ”choke” anastomoses or by the so-called the “true” anastomoses, that regulate blood flow to the skin without any change in caliber.

Choke vessels provide an initial resistance to blood flow between base and the tip of a flap, but when a flap is delayed by strategic division of cutaneous perforators, they dilate to the dimensions of true anastomoses, thus enhancing the circulation to the distal flap.