皮蒂在穿支筋膜蒂皮瓣中的作用探讨
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摘要
目的进一步阐明穿支筋膜皮瓣的皮蒂对皮瓣的静脉引流和动脉输入的作用。方法 40只重约300g的雄性SD大鼠,在背部切取大小为9 cm×3 cm的皮瓣后,等分入以下4组:穿支完好组(蒂部穿支保留完好)、动脉缺失组(结扎蒂部动脉)、静脉缺失组(结扎蒂部静脉)及穿支缺失组(结扎动静脉)。术后7 d使用激光多普勒血流仪监测皮瓣血液灌注,计算皮瓣坏死率,测量皮蒂血管的直径。结果激光多普勒血流仪提示穿支完好组与静脉缺失组的灌注模式相似,穿支缺失组与动脉缺失组的灌注模式相似。穿支完好组和静脉缺失组的血流灌注量更大。穿支缺失组皮瓣的坏死率(26±1)%与动脉缺失组皮瓣的坏死率(29±1)%无显著差异,但均显著高于穿支完好组(11±3)%和静脉缺失组(12±4)%皮瓣的坏死率(P<0.001)。静脉缺失组和穿支缺失组的皮肤基底部静脉网明显扩张,而动脉缺失组和穿支完好组的动脉网管径轻度增大。结论穿支筋膜皮瓣的皮蒂作为静脉引流额外通道的作用比其作为动脉输入的作用更加重要。
Objective To investigate the exact role of a skin pedicle in serving arterial perfusion or venous outflow in flap survival. Methods 40 male SD rats weighing 300 g were used in this study and divided into the following 4 groups after harvesting of a flap with a size of 9×3cm on the back: perforatorcomplete group(perforator preserved in the pedicle), artery-deficit group(ligation of the perforating artery),vein-deficit group(ligation of the perforating vein), and perforator-deficit group(ligation of the perforator). A laser Doppler flowmeter was used to monitor the flap perfusion after surgery, and the flap necrosis rate was calculated and the vascular diameter at the skin pedicle was measured at day 7. Results The data of the laser Doppler flowmeter indicated a similar perfusion pattern between the perforator-complete group and the vein-deficit group, as well as between the perforator-deficit group and the artery-deficit group. The perfusion in the perforator-complete group and the vein-deficit group was much stronger. The necrosis rate was(26 ±1) % in the perforator-deficit group, which was not significantly different from the necrosis rate of being(29±1) % in the artery-deficit group, both of which were significantly larger than the necrosis rate being(11±3)%and(12 ± 4)%, respectively, in the perforator-complete group and the vein-deficit group(P<0.001). The venous network in the skin base was extremely dilated in the skin base in the vein-deficit and perforatordeficit group, whereas the arterial network was modestly dilated in the artery-deficit and perforator-complete group. Conclusion The skin base in the perforator-plus group is more important as an additional route for venous backflow than as an additional arterial input.
Objective To investigate the exact role of a skin pedicle in serving arterial perfusion or venous outflow in flap survival. Methods 40 male SD rats weighing 300 g were used in this study and divided into the following 4 groups after harvesting of a flap with a size of 9×3cm on the back: perforatorcomplete group(perforator preserved in the pedicle), artery-deficit group(ligation of the perforating artery),vein-deficit group(ligation of the perforating vein), and perforator-deficit group(ligation of the perforator). A laser Doppler flowmeter was used to monitor the flap perfusion after surgery, and the flap necrosis rate was calculated and the vascular diameter at the skin pedicle was measured at day 7. Results The data of the laser Doppler flowmeter indicated a similar perfusion pattern between the perforator-complete group and the vein-deficit group, as well as between the perforator-deficit group and the artery-deficit group. The perfusion in the perforator-complete group and the vein-deficit group was much stronger. The necrosis rate was(26 ±1) % in the perforator-deficit group, which was not significantly different from the necrosis rate of being(29±1) % in the artery-deficit group, both of which were significantly larger than the necrosis rate being(11±3)%and(12 ± 4)%, respectively, in the perforator-complete group and the vein-deficit group(P<0.001). The venous network in the skin base was extremely dilated in the skin base in the vein-deficit and perforatordeficit group, whereas the arterial network was modestly dilated in the artery-deficit and perforator-complete group. Conclusion The skin base in the perforator-plus group is more important as an additional route for venous backflow than as an additional arterial input.
引文
[1]Koshima I,Soeda S.Inferior epigastric artery skin flaps without rectus abdominis muscle[J].Br J Plast Surg,1989,42(6):645-648.
[2]Hallock GG.Lower extremity muscle perforator flaps for lower extremity reconstruction[J].Plast Reconstr Surg,2004,114(5):1123-1130.
[3]Galanis C,Nguyen P,Koh J,et al.Microvascular lifeboats:a stepwise approach to intraoperative venous congestion in DIEP flap breas reconstruction[J].Plast Reconstr Surg,2014,134(1):20-27.
[4]Wei JW,Ni JD,Dong ZG,et al.Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg,ankle,and foot:comparison between pediatric and adult patients[J].J Reconstr Microsurg,2014,30(4):249-254.
[5]高建明,郭峰,刘云鹏,等.小腿皮神经营养血管筋膜皮瓣的临床应用[J].中国临床解剖学杂志,2008,26(4):446-450.
[6]Mehrotra S.Perforator-plus flaps:a new concept in traditional flap design[J].Plast Reconstr Surg,2007,119(2):590-598.
[7]Mesic H,Kirkeboen KA,and Bains R.The importance of a skin bridge in peripheral tissueperfusion in perforator flaps[J].Plast Reconstr Surg,2012,129(3):428e-434e.
[8]薛兰,吴志海,汤莹莹,等.激光多普勒对大鼠背部3种皮瓣模型的血流动力学特点研究[J].中国临床解剖学杂志,2016,34(1):6-11.
[9]Chang SM,Wang X,Huang YG,et al.Distally based perforator propeller sural flap for footand ankle reconstruction:a modified flap dissection technique[J].Ann Plast Surg,2014,72(3):340-345.
[10]Park SO,Ahn KC,Hong KY,et al.External jugular venoaccompanying artery adipofascial flap:A novel and convenient flap for head and neck reconstruction[J].Head Neck,2017,39(11):2249-2255.
[11]Zhuang YH,Zheng HP,Lin SQ,et al.Vasculature at the medial aspect of the foot and clinicalapplication of flaps based on it for forefoot reconstruction[J].Plast Reconstr Surg,2011,127(5):1967-1978.
[12]Mehrotra S.Perforator-plus concept:adding versatility to traditional flaps[J].Plast Reconstr Surg,2009,123(6):219e-220e.
[13]Pafitanis G,Raveendran M,Myers S,et al.Flowmetry evolution in microvascular surgery:Asystematic review[J].J Plast Reconstr Aesthet Surg,2017,70(9):1242-1251.
[14]刘旭东,曾炳芳.激光多普勒血流监测仪的原理及应用[J].中国医疗器械信息,2007,11(2):22-23.
[15]杨小杰.激光多普勒血流仪在微循环实验和教学中的应用[J].中国现代药物应用,2013,7(9):188-189.
[16]Niranjan NS,Price RD,and Govilkar P.Fascial feeder and perforatorbased V-Y advancementflaps in the reconstruction of lower limb defects[J].Br J Plast Surg,2000,53(8):679-689.
[17]Tao Y,Ding M,Wang A,et al.Basic perforator flap hemodynamic mathematical model[J].Plast Reconstr Surg Glob Open,2016,4:e714.
[18]Zhuang Y,Xie Y,Wu Z,et al.Hemodynamic study of three patterns of flaps on rats with a novel panoramic photographing technique involved[J].Plast Reconstr Surg,2016,138(4):653e-665e.
[19]Chang H,Nobuaki I,Minabe T,et al.Comparison of three different supercharging procedures in a rat skin flap model[J].Plast Reconstr Surg,2004,113(1):277-283.
[20]郑俊,习珊珊,李红,等.静脉超引流与动脉增压对皮瓣存活的影响[J].解剖学报,2016,47(3):359-364.
[2]Hallock GG.Lower extremity muscle perforator flaps for lower extremity reconstruction[J].Plast Reconstr Surg,2004,114(5):1123-1130.
[3]Galanis C,Nguyen P,Koh J,et al.Microvascular lifeboats:a stepwise approach to intraoperative venous congestion in DIEP flap breas reconstruction[J].Plast Reconstr Surg,2014,134(1):20-27.
[4]Wei JW,Ni JD,Dong ZG,et al.Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg,ankle,and foot:comparison between pediatric and adult patients[J].J Reconstr Microsurg,2014,30(4):249-254.
[5]高建明,郭峰,刘云鹏,等.小腿皮神经营养血管筋膜皮瓣的临床应用[J].中国临床解剖学杂志,2008,26(4):446-450.
[6]Mehrotra S.Perforator-plus flaps:a new concept in traditional flap design[J].Plast Reconstr Surg,2007,119(2):590-598.
[7]Mesic H,Kirkeboen KA,and Bains R.The importance of a skin bridge in peripheral tissueperfusion in perforator flaps[J].Plast Reconstr Surg,2012,129(3):428e-434e.
[8]薛兰,吴志海,汤莹莹,等.激光多普勒对大鼠背部3种皮瓣模型的血流动力学特点研究[J].中国临床解剖学杂志,2016,34(1):6-11.
[9]Chang SM,Wang X,Huang YG,et al.Distally based perforator propeller sural flap for footand ankle reconstruction:a modified flap dissection technique[J].Ann Plast Surg,2014,72(3):340-345.
[10]Park SO,Ahn KC,Hong KY,et al.External jugular venoaccompanying artery adipofascial flap:A novel and convenient flap for head and neck reconstruction[J].Head Neck,2017,39(11):2249-2255.
[11]Zhuang YH,Zheng HP,Lin SQ,et al.Vasculature at the medial aspect of the foot and clinicalapplication of flaps based on it for forefoot reconstruction[J].Plast Reconstr Surg,2011,127(5):1967-1978.
[12]Mehrotra S.Perforator-plus concept:adding versatility to traditional flaps[J].Plast Reconstr Surg,2009,123(6):219e-220e.
[13]Pafitanis G,Raveendran M,Myers S,et al.Flowmetry evolution in microvascular surgery:Asystematic review[J].J Plast Reconstr Aesthet Surg,2017,70(9):1242-1251.
[14]刘旭东,曾炳芳.激光多普勒血流监测仪的原理及应用[J].中国医疗器械信息,2007,11(2):22-23.
[15]杨小杰.激光多普勒血流仪在微循环实验和教学中的应用[J].中国现代药物应用,2013,7(9):188-189.
[16]Niranjan NS,Price RD,and Govilkar P.Fascial feeder and perforatorbased V-Y advancementflaps in the reconstruction of lower limb defects[J].Br J Plast Surg,2000,53(8):679-689.
[17]Tao Y,Ding M,Wang A,et al.Basic perforator flap hemodynamic mathematical model[J].Plast Reconstr Surg Glob Open,2016,4:e714.
[18]Zhuang Y,Xie Y,Wu Z,et al.Hemodynamic study of three patterns of flaps on rats with a novel panoramic photographing technique involved[J].Plast Reconstr Surg,2016,138(4):653e-665e.
[19]Chang H,Nobuaki I,Minabe T,et al.Comparison of three different supercharging procedures in a rat skin flap model[J].Plast Reconstr Surg,2004,113(1):277-283.
[20]郑俊,习珊珊,李红,等.静脉超引流与动脉增压对皮瓣存活的影响[J].解剖学报,2016,47(3):359-364.