摘要
目的：探讨浅静脉干及其滋养血管在逆行皮瓣早期再血管化过程中所起的作用，明确在逆行皮瓣中完整的浅静脉干及其滋养血管网的存在是否对皮瓣早期血管化进程产生积极影响，从而明确其是否对皮瓣存活有利，为带浅静脉干的逆行皮瓣的临床应用提供理论依据。
方法：1．应用生物体视学原理和技术检测带浅静脉干的逆行皮瓣移植后早期微血管密度量的变化趋势，与不带静脉干逆行皮瓣作对照比较。2．组织切片观察带浅静脉干的逆行皮瓣血管网的生长、重建、分布等情况。3．皮瓣成活研究。4．临床应用研究：分别在掌背、小腿部制作带浅静脉干的逆行皮瓣，修复患部组织缺损10例。
结果：1．证实带浅静脉干的逆行皮瓣移植后早期微血管长度密度和体积密度逐渐增高，量的变化与不带浅静脉干的皮瓣对照比较有显著性差异。2．组织学观察证实从移植后第3天开始实验组皮瓣有较多新生毛细血管，微血管有侧枝发芽，血管间有吻合沟通。5～7天时微血管密度达到高峰，见大量新生毛细血管形成，血管间吻合丰富，管腔内有血液充盈。组织间可见大量炎症细胞浸润。10天显示仍有新生毛细血管，但增长趋势减缓；管腔血液充盈较好，静脉干管腔内有血细胞，无明显血栓形成，组织间炎细胞减少。对照组皮瓣亦有毛细血管增生，血管增生与同期实验组皮瓣相比较不明显，血管网间吻合较少，血管腔内可见微血栓形成，血管充盈较差。组织间炎症细胞浸润情况与实验组皮瓣类似。3．带浅静脉干的逆行皮瓣移植后成活优于不带浅静脉干的逆行皮瓣，成活率平均相差约12个百分点。4．临床应用10例，皮瓣存活良好，仅一例皮瓣有少许表浅坏死，换药后完全愈合。
结论：浅静脉干及其滋养血管网对皮瓣早期再血管化过
程具有促进作用，提示在逆行皮瓣中保留浅静脉干对皮瓣存
活有利。
Objective:
To study the effects of superficial venous trunk (SVT) and its norishing vessels on revascularization in reverse-flow random flaps, to make clear picture of the problem whether the existence of SVT and its norishing vessels can improve the revascularization of reverse-flow flaps early in the transplantation so as to supply the theoretical evidences to the clinical applications. Methods:
( 1 ) The morphologic changes of micrangium between the reverse-flow random flap with SVT and no SVT in different phase were observed by using optical microscopy, stereological methods. (2) survival study of reverse-flow flaps with SVT and no SVT of pigs.To compare the survival ratio of 2 groups of flaps including SVT and no SVT (3 ) Clinical practice of reverse-flow random flaps. Results:
(1) The micrangium density of skin flaps in both of group I and group II had increasing trend after operation of 3 days.After operation of 3,5,7and 10 th day, the micrangium density in group I were much than that in group II .There is significant difference between the group, which is also proved by the optical icroscopy. ( 2 ) The reverse-flow flaps with SVT intact had the better survival ratio. (3) This flap has been used in 10 cases, all of which succeeded and no one failed. Conclusion:
the micrangium density of group I is much higher than that in group II , which suggests that SVT and its norishing vessels can promote the revascularization of the flap early in the transplantation, and the clinical application of the flap shows that the SVT can be of
benefit to the survival of reverse-flow random flap.
引文
1 钟世镇．皮瓣静脉干的类型及其选用原则．中华手外科杂志．1994，10：103～104．
2 熊明根．带浅静脉干局部皮瓣的基础与临床．中国美容外科杂志．2001；10：368～370．
3 张世民．浅静脉干对四肢远端蒂皮瓣作用的实验研究．中国临床解剖学杂志．2001；19：175～176．
4 张世民，顾玉东，李继峰．浅静脉干不同处理方法对远端带蒂皮瓣影响的实验研究．中华手外科杂志．2003；19：36～38．
5 康安，熊明根。兔耳逆行皮瓣中浅静脉干的压强测定．中国美容外科杂志．2001；10：378～379．
6 熊明根．浅静脉干及其滋养血管放射自显影动物实验研究．中国美容外科杂志．2001：10：373～375．
7 康安，熊明根．逆行皮瓣中浅静脉干血流动力学的SPECT研究．中国美容外科杂志．2001；10：178～180．
8 康安．带浅静脉干逆行皮瓣的微循环观察．广东医学．2001；22：478～479．
9 康安，熊明根．猪带浅静脉干逆行皮瓣的经皮血气分析．中国美容外科杂志．2001：10：381～383．
10 熊明根．浅静脉干在皮瓣成活中的作用实验研究．中国美容外科杂志．2001；10：375～377．
11 康安，熊明根．带浅静脉干逆行皮瓣的应用研究．中国美容外科杂志．2001：10：370～371．
12 Goss CM,Gray's anatomy of the human body[J].Sannders. 1980;6:132.
13 AA noreldin, K Fukuta.Role of perivenous areolartissue in the viability of venous flaps: an experimental study on the inferior epigastric venous flap of the rat[J]. Br J Plast Surg. 1992;45:18.
14 Del Pinal F,Taylor GI.The deep venous system and reverse flaps[J]. Br J Plast Surg. 1993 ;46:652.
15 Nobuaki Imnishi, Hideo Nakajima,Sadakazu Aiso. A radiographic perfution study of the cephalic venous flap[J].Plast Reconstr Surg. 1996;97:408.
16 熊明根，罗奇．浅静脉干及其滋养血管对静脉皮瓣成活的影响．中华显微外科杂志．2000；23：294～295．
17 Del Pinal F, Taylor GI.The deep venous system and reverse flow flaps.Br J surg,1992,46:652
18 孙博．前臂挠侧岛状逆行皮瓣静脉回流的解剖学研究．临床应用解剖学杂志,2001，2：188
19 SD Lin,CS Lai,CC Chiu.Venous drainage in the reverse forearm flap.Plast Reconstr Surg, 1984,74:508
20 Timmons MD,William Harvey. Reverse flow through valves of the forearm veins, lancet. 1984;2:394～399.
21 Torri S,Namiki Y, Meri R.Reverse flow island flap:clinical report and venous drainage.Plastic Reconstr Surg, 1987,79:600
22 Timmons MJ.The deep venous system and reverse flow flaps.Br J Plast Surg, 1994,47:290
23 Chang SM,Chen ZW.Can superficial vein reverse flow through valves in distally based fasciocutanous flaps?Plast Reconstru Surg,1991,87:995
24 金范学，李春爱．静脉血营养的静脉皮瓣微血管密度的实验观察．延边大学医学学报．2003，26：2
25 熊明根．浅静脉干及其滋养血管放射自显影动物实验研究．中国美容外科杂志．2001；10：373～375．
26 Goss CM,Gray's anatomy of the human body[J].Sannders. 1980;6:132.
27 AA noreldin,K Fukuta.Role of perivenous areolartissue in the
viability of venous flaps:an experimental study on the inferior epigastric venous flap of the rat[J].Br J Plast Surg. 1992;45:18.
28 Nobuaki Imnishi, Hideo Nakajima, Sadakazu Aiso. A radiographic perfution study of the cephalic venous flap[J].Plast Reconstr Surg. 1996;97:408.
29 熊明根，司徒扑，陈兵，等．四肢带表浅静脉干的局部皮瓣在创伤修复中的应用．中华整形烧伤外科杂志，1995，11：81
30 熊明根，司徒扑，王晋煌．静脉逆行岛状皮瓣修复指掌侧皮肤缺损．中华手外科杂志，1994，10：4
31 康安，熊明根．远端蒂皮瓣的静脉回流．中国临床解剖学杂志，2001，19：118
32 Timmons MJ,William Harver revisited:reverse flow through the valves of forearm veins.Lancet,1984,11:394
33 H Nakajima,N Imanishi,S Aiso,et al.Venous drainage of the radical forearm and anterior tibial reverse flow flaps:anatomical and radiographic perfution studies,Br J Plast Surg, 1997,50:389
34 金范学，许松日，陈华勇．静脉血营养的静脉皮瓣血液循环途径的实验研究．延边大学医学学报．2002，25：237
35 Clavion JP．Island flap with an exclusively venous pedicle．[J]Brit J Plast Reconstr Surg．1987,40：149
36 王绪凯，严冬，刘永权．碱性成纤维细胞生长因子对预构皮瓣血管化及成活的影响．中华整形外科杂志．2002，18：5,278
37 Tomas ka,Gimenez Galliego. Fibroblast growth factor broad spectrum mitogens with potent angiogenic activity.Trands biochem Sic 1986,11:81
38 张培礼，李健宁．预构皮瓣研究进展．中华微创外科杂志．2002，2；2，130
39 任晓平，刘淑学，汪洋等．静脉游离移植预构动脉网状皮瓣的实验研究．中华骨科杂志．1994，6：350～351
40 Shen TV.Vascular implation into skin flap experimental study and clinical application:a preliminary report.Plast Reconstru Surg, 1984.73:403
41 Orenstein A, M azkereth R,Tsur H.Mapping of the human body skin with the transcutanous oxygen pressure method.Ann Plast Surg, 1988,20:419
42 Glodberg J,Scpka RS,Perona BP, et al.Laser Doppler blood flow measurement of common cutaneous doner sites for reconstructive surgery.Plast Reconstr Surg, 1990,85:581
43 申洪，王德文涂，开成．我国生物体视学和定量病理学发展的世纪回顾及展望．中国体视学与图象分析．2001，6：60
张宪涛，刘玉梅．生物体视学研究进展及应注意问题．山东医科大学学报．1998，2：11
44 Pasyk KA,Thomas SV, Hassett CA,et al.Reginal differences in capillary density of the normal human dermis.Plast Reconstru Surg,1989,83:939～941
45 周国富，黄广孚，任林森．皮肤快速扩张的组织形态学和体视学研究．中国修复重建外科杂志，1997，11：76
46 刘兴坤，张永福，廖健兴．婴幼儿皮肤毛细血管密度的区域性差异酶组织化学结合体视学研究．中华整形烧伤外科杂志．1998，14：448
47 李森恺，杨明勇，李养群．指背旗形皮瓣的实验研究及临床应用．中华整形烧伤外科杂志．1997，3：165
48 Smith PJ. The importance of venous drainage in axial pattern flaps.Br J Plast Surg,1978,31:233
49 陈伯华，司徒扑，徐达传，等．真皮下血管网皮瓣成活长度的实验研究．中华显微外科杂志．1994，17：280
50 陈伯华，司徒扑，徐达传．颈肩肱部真皮下血管网皮瓣的血供特点．中华烧伤创疡杂志．1994，1：50
51 Ahmed A, Dunk C, Kniss D,et al.Role of VEGF receptor in
mediating calcium-dependent nitric oxide release and limiting DNA synthesis in human trophoblast cells. Lab invest, 1997,76:779
52 陈英，原林，主译．干细胞研究的进展与未来．广州：第一军医大学解剖教研室．2001，13-121