摘要
目的以新西兰大白兔隐动静脉逆行岛状皮瓣为实验模型，探讨结扎血管蒂伴行静脉干对逆行岛状皮瓣存活的影响。方法将10只新西兰大白兔两侧后肢左右随机分为2组，每组10个皮瓣，进行同体对照。建立隐动静脉逆行岛状皮瓣实验模型（面积3cm×3cm，血管蒂长4cm，血管蒂周围保留1cm宽筋膜）。对照组：血管蒂部不做任何处理；实验组：在放大10倍手术显微镜视下于血管蒂的两端分别结扎伴行静脉干，使2根伴行静脉干完全闭塞。术后每天观察皮瓣颜色、肿胀情况。术后1周测皮瓣成活率，并切取血管蒂进行组织学观察。结果术后两组皮瓣均有较明显的肿胀，实验组皮瓣肿胀更为明显。两组皮瓣平均成活率比较，对照组为（92．7±12．1）％，实验组为（46．8±38．3）％，差异有统计学意义（t=3．61，P〈0．01）。两组皮瓣蒂部均可见扩张的微血管，高度肿胀导致坏死的皮瓣，在其蒂部扩张的微血管内可见血栓形成。结论血管蒂的伴行静脉结扎使皮瓣更易发生静脉危象，导致皮瓣坏死。微血管内血栓形成可能是导致皮瓣静脉回流障碍的又一重要因素。
Objective To evaluate the effect of ligafing venue commutantes in the pediele on the survival of reverse-flow island flaps. Methods Ten New Zealand rabbits were used. Reverse flow island flap based on the sapbenous artery and vein was created on both lfind limbs, with a total of 20 flaps. The size of the flap was 3 cm×3 cm with a 4 cnl long vascular pedicle containing 1 em strip of connective tissue. These flaps were randomly divided into 2 groups of 10 flaps each. In group I , the vascular pedicle （ 1 saphenous artery and 2 venue eommutantes） was raised and its sheath was not disturbed, maintaining communicating and collateral branches intact. In group , the 2 venue connnutantes were ligated wit, 8-0 suture at both ends of the pedicle under 10X microscope and the connective tissue was maintained intact. The eolor and congestion of flaps were observed daily. Flap survival rate was measured after one week. The vascular pedicle was harvested and observed histologically. Restuls The flaps began to appear obviously swelling after blood oozing stopped. The extent of swelling was more severe in group H than in group I . Flap survival rate of group Ⅰ （92.7 ± 12.1）% was significantly higher than that of group H （46.8 ± 38.3） % （ t = 3.61, P 〈 0.01 ）. Histological examination revealed lots of dilated venules in the vascular pedlcle. The amount of dilated venules in group H was more than that in group I . Lots of thrombi could be see,, in the dilated venules in the pedicle of completely or partially necrotic flaps. Conclusion Venous crisis takes place more easily in flaps without venae commutantes, resulting in flap necrosis. The venous thrombosis may be the other important influencing factor for necrosis of reverse-flow flaps.
出处
《中华手外科杂志》
CSCD
北大核心
2011年第3期181-184,共4页
Chinese Journal of Hand Surgery
基金
国家自然科学基金资助项目（30571896）
关键词
岛状皮瓣
静脉
动物实验
Island flaps
Veins
Animal experimentation
