不同断蒂时间下肌皮瓣的血运重建情况
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摘要
目的:以前期建立的兔背阔肌肌皮瓣带蒂移植模型,探索肌皮瓣移植术后不同时间点的血运重建情况,确定肌皮瓣移植后最佳断蒂时间。方法:采用新西兰大耳白兔20只,一期复制背阔肌肌皮瓣带蒂移植模型,二期行断蒂术并按断蒂时间不同分为2w组、3w组、4w组和5w组,每组5只。术后7d进行取材,观察各组肌皮瓣的大体存活情况、肌纤维及微血管密度的改变。结果:各组间皮瓣平均存活率5w>4w>3w>2w,结果有统计学意义(P<0.05);肌纤维的形态及微血管计数结果与肌皮瓣存活率相符。结论:肌皮瓣带蒂移植血运重建直至完全建立可能需要5w,推断其最佳断蒂时间是移植术后5w。
Objective To reveal optimal pedicle division time by investigating revascularization and survival rates of musculocutaneous flaps at different time points postoperatively. This study was based on the model of pedicle latissimus dorsi musculocutaneous flap in rabbit. Methods Twenty New Zealand white rabbits were used to replicate the pedicled transplantation model of latissimus dorsi myocutaneous flap in stageⅠ. Stage Ⅱ pedicled transection was performed and divided into 2 w group, 3 w group, 4 w group and 5 w group according to the time of pedicle breakage, with 5 rats in each group. The gross survival, muscle fiber and microvessel density of myocutaneous flap in each group were observed 7 days after operation. Results The average survival rate of skin flap was 5 w>4 w>3 w>2 w, the results were statistically significant(P <0.05), and the morphology and microvessel count of muscle fiber were consistent with the survival rate of myocutaneous flap. Conclusion The revascularization of musculocutaneous flaps completed at least 5 weeks. Therefore, the appropriate time of musculocutaneous flap division was 5 weeks.
Objective To reveal optimal pedicle division time by investigating revascularization and survival rates of musculocutaneous flaps at different time points postoperatively. This study was based on the model of pedicle latissimus dorsi musculocutaneous flap in rabbit. Methods Twenty New Zealand white rabbits were used to replicate the pedicled transplantation model of latissimus dorsi myocutaneous flap in stageⅠ. Stage Ⅱ pedicled transection was performed and divided into 2 w group, 3 w group, 4 w group and 5 w group according to the time of pedicle breakage, with 5 rats in each group. The gross survival, muscle fiber and microvessel density of myocutaneous flap in each group were observed 7 days after operation. Results The average survival rate of skin flap was 5 w>4 w>3 w>2 w, the results were statistically significant(P <0.05), and the morphology and microvessel count of muscle fiber were consistent with the survival rate of myocutaneous flap. Conclusion The revascularization of musculocutaneous flaps completed at least 5 weeks. Therefore, the appropriate time of musculocutaneous flap division was 5 weeks.
引文
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[12] Enajat M,Rozen WM,Whitaker IS,et al.How long are fasciocutaneous flaps dependant on their vascular pedicle:a unique case of SIEA flap survival[J].J Plast Reconstr Aesthet Surg,2010,63(4):e347-e350.
[13]Tsur H,Daniller A,Strauch B,et al.Neovascularization of skin flaps:route and timing[J].Plast Reconstr Surg,1980,66:85-90.
[14]鲁晓波,郝建伟,王兆强.早期反复短时缺血训练对皮瓣成活的影响及其机制研究[J].中国修复重建外科杂志,2006,20(7):717-721.
[2]刘志军,何忠良,沈立峰,等.游离股外侧肌皮瓣移植术治疗慢性脓胸和胸壁窦道疗效分析[J].浙江医学,2019,41(4):62-64.
[3]Park CW,Kim YH,Hwang KT,et al.Reconstruction of a severely crushed leg with interpositional vessel grafts and latissimus dorsi flap[J].Arch Plast Surg,2012,39(4):417-421.
[4]刘在波,修文娟.背阔肌皮瓣联合假体在乳腺癌改良根治术后乳房重建中的应用[J].医学信息,2019,32(2):135-136.
[5]Dennis M,Granger A,Ortiz A,et al.The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty[J].Clin Anat,2018,31(2):152-159.
[6]张娟,陈建武,张栋梁,等.一种新型兔肌皮瓣带蒂移植模型[J].中国美容整形外科杂志,2016,27(12):748-751.
[7]Lorenzetti F,Ahovuo J,Suominen S,et al.Colour Doppler ultrasound evaluation of haemodynamic changes in free tram flaps and their donor sites[J].Scand J Plast Reconstr Surg Hand Surg,2002,36:202-206.
[8]Machens HG,Pallua N,Pasel J,et al.Persistence of pedicle blood flow up to 10 years after free musculocutaneous tissue transfer[J].Plast Reconstr Surg,1998,101:719-726.
[9]Clarke HM,Howard CR,Pynn BR,et al.Delayed neovascularization in free skin flap transfer to irradiated beds in rats[J].Plast Reconstr Surg,1985,75:560-564.
[10]马赞林,王毅,马莉琼,等.大鼠横型腹直肌缺血肌皮瓣模型血运特点[J].宁夏医科大学学报,2013,35(11):1226-1228.
[11]Heil M,Eitenmuller I,Schmitz-Rixen T,et al.Arteriogenesis versus angiogenesis:similarities and differences[J].J Cell Mol Med,2006,10(1):45-55.
[12] Enajat M,Rozen WM,Whitaker IS,et al.How long are fasciocutaneous flaps dependant on their vascular pedicle:a unique case of SIEA flap survival[J].J Plast Reconstr Aesthet Surg,2010,63(4):e347-e350.
[13]Tsur H,Daniller A,Strauch B,et al.Neovascularization of skin flaps:route and timing[J].Plast Reconstr Surg,1980,66:85-90.
[14]鲁晓波,郝建伟,王兆强.早期反复短时缺血训练对皮瓣成活的影响及其机制研究[J].中国修复重建外科杂志,2006,20(7):717-721.