颈肩峰区跨区供血轴型扩张皮瓣修复颈部瘢痕挛缩

目的 探讨颈肩峰区跨区供血轴型扩张皮瓣的解剖学特征及应用于修复颈部瘢痕挛缩的临床效果.方法 应用颈横动脉分支和胸肩峰动脉吻合支跨区供血,形成前界为锁骨、后界为肩胛岗、外界为肩峰的颈肩峰区的扩张皮瓣,以颈侧为蒂转移修复较大面积的颈部软组织缺损.结果 15例患者的19个颈肩峰扩张皮瓣(面积最大为23 cm× 16 cm)全部成活,颈部畸形矫正良好.结论 颈肩峰区跨区供血的吻合支丰富,于深筋膜浅层进行扩张后皮下脂肪层及皮肤较薄,可以形成较大面积的扩张皮瓣,以颈横动脉颈段皮支为轴型血管,转移修复颈部较严重的瘢痕挛缩畸形,是一个良好的手术方法.     

小切口阻断血管延迟反流轴型皮瓣的研究

目的 探讨小切口阻断血管对反流轴型皮瓣转移前延迟效应的作用机制及对皮瓣成活的影响.方法 80只健康Wistar大鼠随机分为实验组（小切口手术延迟组）与对照组（皮瓣即刻转移组）,每组40只,实验组皮瓣分别再分成延迟1周组,延迟2周组,延迟3周组和延迟4周组,每组10只.选取自大鼠下背部髂腰动脉区域面积5 cm×1 cm,跨越中线区2.5 cm,作为反流轴型皮瓣模型.小切口手术结扎阻断其一侧供血的血管,比较术后各组皮瓣成活率、毛细血管密度、乳酸含量的改变.结果 随着延迟时间的延长,实验组皮瓣成活率增加.实验组延迟3周组、延迟4周组皮瓣的成活率分别是（86.13±1.13）％、（93.49±1.15）％,而对照组的成活率基本相同.实验组皮瓣随着延迟时间的延长,血管密度增加,但延迟3周组与延迟4周组密度相近（P＞0.05）.实验组皮瓣乳酸浓度在延迟1周组最高,随着延迟时间的延长,乳酸浓度逐渐下降,但乳酸含量在延迟3周组和延迟4周组并不逐渐下降,而处于一个相对稳定值.对照组皮瓣乳酸含量基本不变.结论 以大鼠背部跨区轴型皮瓣为实验模型,小切口手术结扎阻断其一侧供血的血管,造成皮瓣内环境缺血、缺氧的改变,引起组织缺血、缺氧耐受,导致皮瓣血管管腔扩大,吻合血管数目增多,皮瓣成活率高,可以起到延迟转移的效果.     

跨区反流轴型皮瓣成活机理的实验研究

目的了解反流轴型皮瓣的成活机理. 方法以Wistar大白鼠左旋髂深血管为蒂,形成8.0 cm×2.5 cm横跨腰背部中线4.0 cm的矩形皮瓣,作为反流轴型皮瓣模型,观察其成活过程中动脉供血和静脉回流的途径、方向和流速、血管管径和管内压力、血流量及血管构筑的改变. 结果皮瓣完全成活率100%,术前中线两侧动脉压差约等于0,术后皮瓣近、远端灌注压差达4.9 kPa;轴心动脉经中线吻合支向对侧供血,经静脉吻合支回流;中线以远区域的血流方向与术前相反.术后48 h内,皮瓣远端血流量仅为术前的1/8～1/5,中线区静脉压高于远端,6例的皮瓣远端静脉淤血;72 h后中线区血管吻合支增多、增粗,静脉压低于远端,远端淤血开始缓解;轴心血管沿吻合支逐渐向中线以远延伸,14 d形成与顺流皮瓣相似的轴心血管,血流量基本恢复到术前水平. 结论反流轴型皮瓣经两侧轴心血管之间的吻合支供血和回流,其动力是吻合支两侧的动、静脉压差.术后72 h内易出现静脉回流障碍,此期皮瓣以代偿性的吻合支增粗、增多及压力下降维持其循环;72 h后,与顺流轴型皮瓣相似的轴心血管逐渐形成, 为皮瓣成活提供了可靠的循环.     

相邻接轴型皮瓣间血管交通支于皮肤扩张术后变化的定量研究

目的以血管造影的方法，观察相邻接轴型皮瓣间血管交通吻合支于皮肤扩张术后变化的定量分析研究，为皮瓣的血供提供更加确凿的依据。方法于巴马猪双侧侧腹壁形成以旋髂深血管为蒂的轴型皮瓣，并分别与双侧的腹壁上动静脉轴型皮瓣相连，一侧于血管交接部位埋置皮肤扩张器为实验组，另一侧为非扩张对照组。扩张完成后，于颈动脉灌注明胶一氧化铅混悬液，获得皮肤血管的x线影像。在该图像上两血管大致的交通部位设计等距的3条平行线垂直于两血管的长轴方向，总的宽度以能覆盖所有的交通支为准，计数平行线与该区域内的血管支的切割数，并进行统计学分析。结果实验组平行线与交接区动脉切割数为81．20±10．33，对照组为22．40±5．41，两组之间比较差异有统计学意义（P〈0．01）。结论血管交通支的计量方法能真实反映血管交通支的改变，并可运用于其他实验和临床的相关研究。     

应用枕动脉跨区供血头皮瓣修复头皮肿瘤术后大面积复杂头皮缺损

目的 探讨头皮肿瘤切除术后大面积、复杂头皮缺损的修复方法.方法 应用枕动脉跨区供血的头皮瓣,修复伴有骨膜、颅骨缺失的占头皮1/3～1/2(8cm×6cm～14cm×13cm)的大面积头皮缺损者9例.结果 9例患者的枕动脉跨区供血反流轴型皮瓣全部成活,创面均Ⅰ期修复,术后随访3～42个月,头皮肿瘤未见复发,效果满意.结论 枕动脉与头皮其他血管之间存在广泛、稳定的吻合支,血运丰富,以枕动脉为供血动脉,跨区切取大面积的头皮瓣,一次修复头部肿瘤切除术后大面积复杂头皮缺损,是一种安全、可靠、有效的方法.     

跨区供血皮瓣成活过程中血管构筑及内源性VEGF变化的实验研究

目的：探索跨区供血皮瓣的成活机制。方法：以大鼠旋髂深动脉为蒂制作包含肋间后动脉支配区域的右侧背部矩形跨区供血皮瓣，分别于术后即刻，术后1，2，3，5，7天时，观察皮瓣成活情况，成活过程中血管构筑及蒂部血管口径的改变以及内源性血管内皮细胞生长因子（Endogenous Vascular Endothelial Growth Factor，VEGF）免疫组化染色（取材部位为两血管支配区域中间血管网吻合部）。结果：皮瓣完全成活率100％。轴心动脉经吻合支向远端供血，经静脉吻合支回流。血管吻合区以远的血流方向与术前相反。术后即刻VEGF免疫组化染色阴性；1天后血管吻合支与术前相比明显增多、增粗，蒂部血管口径明显增粗，VEGF免疫组化染色阳性区域较多；3天时上述指标达高峰；7天时形成与顺流皮瓣相似的轴心血管，蒂部血管口径有所下降，VEGF免疫组化染色阴性。结论：跨区供血皮瓣的成活机制为血管的口径增大及数量增多，最终形成轴形血管皮瓣。内源性VEGF对皮瓣的成活起重要作用。     

应用超长扩张跨区供血的颈肩轴型皮瓣修复颈胸部瘢痕挛缩

目的：探讨获得较大面积的颈肩轴型皮瓣的可行性，为烧伤后大面积颈胸部瘢痕挛缩畸形提供理想的修复材料。方法：应用软组织扩张技术增加皮瓣的有效面积，设计以颈横动脉及其分支供血的对侧颈肩皮瓣修复颈胸部瘢痕挛缩。结果；临床应用8例，7例皮瓣完全成活。其中1例因超长扩张皮瓣远端出现血运障碍而效果欠佳。结论：由于颈肩背部血供的交叉性及丰富的吻合支存在，即使皮瓣的面积增大并逆主轴血管方向使用，仍能成活良好。     

皮瓣血管交通支的定量研究方法

目的采用血管造影量化相邻血管交通吻合程度,为皮瓣血管研究提供理论依据。方法健康小型猪5头,体长100～115cm,体重25～35kg。一侧腹壁于旋髂深动脉与腹壁上动脉穿支交界区域肉膜下埋植300ml扩张器1枚,每周1次扩张注水,每次30～40ml,扩张2个月(扩张组);另一侧腹壁不作任何处理(非扩张组)。于双侧腹壁设计以旋髂深血管为蒂、20cm×20cm轴型皮瓣10个,并分别携带双侧腹直肌及腹壁上动、静脉。将动物颈总动脉放血处死,颈动脉灌注明胶-氧化铅混悬液后,动物尸体冻存24h,断蒂取下皮瓣,摄皮瓣动脉X线影像。在该图像上于旋髂深动脉和腹壁上动脉大致的交通部位设计等距的3条平行线垂直于2条血管的长轴方向,总宽度以能覆盖所有交通支为佳,计数平行线和这一区域内血管支的切割次数,并进行统计分析。结果扩张组平行线与交界区动脉切割次数为81.20±10.33,非扩张组为22.40±5.41,组间比较差异有统计学意义(P<0.01)。结论设计测量血管交通支的方法简便易行,能真实反映血管交通支的改变,并可用于其他相关实验和临床研究。     

扩张的轴型筋膜皮瓣的临床应用

目的探讨扩张的邻位或远位轴型筋膜皮瓣,在修复面、颈、手部大面积缺损中的效果和优越性。方法在胸、背、腹部深筋膜下,放置1~2枚400~800 ml的矩形扩张器。皮瓣蒂部包含颈横动脉主干及降支、胸肩峰动脉皮穿支、旋髂浅动脉或腹壁浅动脉。扩张的轴型筋膜皮瓣可经1~2次延迟,然后转移至病变切除后的创面。转移后的皮瓣可再次扩张以修复残余病变。结果修复各种病变共35例。除3例皮瓣远端坏死外,其余32例全部成活。最大皮瓣面积40 cm×9 cm。经术后1~12年随访观察,皮瓣色泽正常,柔韧性、延展性好,功能恢复满意,外形美观。结论扩张的邻位或远位轴型筋膜皮瓣技术,不仅使移植皮瓣的血运更加丰富、面积显著增加、厚度明显变薄,而且使皮肤的颜色、质地、感觉均与修复区较相匹配。用其修复面、颈、手部大面积缺损是一种安全可靠、实用有效的方法。     

三维重建术前优化设计腹前外侧跨区游离穿支皮瓣修复四肢软组织缺损

目的探讨三维重建术前优化设计腹前外侧跨区游离穿支皮瓣修复四肢软组织缺损的临床疗效。方法选择2017年10月至2020年1月宁波市第六医院手外科收治的手、前臂、足部及踝关节软组织缺损20例,其中手及前臂组织缺损17例,踝关节及足部软组织及复合组织缺损3例,肢体软组织缺损面积为6 cm×8 cm～36 cm×18 cm。临床结合CTA及三维重建术前优化设计并切取游离跨区穿支皮瓣20例,设计了以下5种皮瓣组合方式:①腹壁下动脉加腹壁上动脉游离穿支皮瓣;②旋髂浅动脉加旋髂深动脉游离穿支皮瓣;③旋髂浅动脉穿支加腹壁下动脉穿支游离穿支皮瓣;④旋髂浅动脉穿支加腹壁浅动脉游离穿支皮瓣;⑤腹壁下穿支动脉加腹壁浅动脉游离穿支皮瓣。皮瓣营养总面积分别为(272.3±12.5)cm2、(107.4±9.3)cm2、(193.6±24.2)cm2、(155.2±20.1)cm2、(203.7±16.3)cm2。术后通过来院门诊复诊随访,观察皮瓣外形、质地、血运、颜色、修复肢体的活动功能、供区恢复及功能情况,供区均予一期直接缝合。结果本组20例腹前外侧跨区穿支皮瓣中,18例顺利成活,1例术后出现部分坏死,经换药后...     

血管内皮生长因子促进跨区供血反流轴型皮瓣成活的实验研究

目的研究血管内皮生长因子（vascular endothelial growth factor，VEGF）的局部皮下注射对大鼠背部跨区供血反流轴型皮瓣成活的影响及效果。方法取20只SD大鼠，制备8cm×2cm大鼠背部跨区供血反流轴型皮瓣模型，随机分成两组，每组10只。实验组：于皮瓣远端7．5cm及6．5cm处共选择4个对称位点，分别予100ng／100μlVEGF溶液50μl；对照组：每一位点予生理盐水50μl。术后1～7d行皮瓣大体观察，并于7d处死大鼠，切取皮瓣，行皮瓣成活率测定、组织学观察及血管密度检测。结果大体观察，实验组皮瓣成活面积明显大于对照组，实验组皮瓣成活面积15．55±0．27cm^2，对照组13．42±0．57cm^2，差异有统计学意义（P〈0.01）。组织学观察，实验组皮瓣血管密度34．40±3．75个／10倍光镜下视野，对照组21．00±3．16个／10倍光镜下视野，差异有统计学意义（P〈0.01）。镜下见实验组有大量新生肉芽组织形成，胶原纤维排列规则，成纤维细胞较多，炎性细胞浸润程度轻；对照组新生肉芽组织少，胶原纤维凝集成块，成纤维细胞少，炎性细胞浸润程度重。结论VEGF在皮瓣成活早期，通过促进缺血皮瓣新生血管形成，增加血管数量，改善缺血组织的血液供应，促进皮瓣成活；在皮瓣形成时局部、单次、足量应用VEGF是促进跨区供血反流轴型皮瓣远端成活的有效方法。     

Effects of vasoactive topical agents on the survival of dorsal skin flaps in rats.

OBJECTIVE: To evaluate 3 vasoactive topical agents regarding their ability to improve the survival of random skin flaps in rats. METHOD: Thirty-five adult Sprague-Dawley rats had a single 9 x 2 cm random skin flap raised with topical application of a white petroleum ointment (control group), prostaglandin E2, minoxidil, or nitroglycerin to the flap. The effect of the agents on the viability of the flaps was evaluated. RESULTS: The control group had an average survival area of 60.8% +/- 7.9%. The nitroglycerin and minoxidil groups were not significantly different, with an average area of survival of 60.1% +/- 8.1% and 63.3% +/- 4.7%, respectively. The prostaglandin E2 group had average area of survival of 74.2% +/- 10.5% (P = 0.002). CONCLUSION: Prostaglandin E2 demonstrated a significant increase in flap survival. Nitroglycerin ointment and minoxidil had no beneficial effects when compared with control.     

撕脱皮瓣修剪成真皮下血管网皮瓣后对成活面积影响的研究

目的研究撕脱皮瓣修剪制成真皮下血管网薄皮瓣后对皮瓣成活面积的影响.方法采用3～4月龄白色约克夏小猪7头,麻醉后在自行研制的皮肤撕脱伤模型机中复制撕脱伤模型,将一侧的撕脱皮瓣制成真皮下血管网薄皮瓣,另一侧为撕脱皮瓣,原位缝合;7天后,对两侧皮瓣的成活和坏死面积进行测量和计算分析.结果修剪制成真皮下血管网薄皮瓣后的成活面积为(60.90±15.26)%,而撕脱皮瓣组的成活面积为(40.41±9.23)%,统计学处理两组有显著差异(P＜0.05).结论皮肤撕脱伤撕脱皮瓣修剪制成真皮下血管网薄皮瓣后增加了成活面积.     

The Effects of Tadalafil on Axial-Pattern Skin Flap Survival in Rats

BACKGROUND Pharmacologic augmentation to mimic the delay phenomenon that increases skin flap survival has been studied extensively. Tadalafil is a phosphodiesterase V inhibitor that is used for treatment of erectile dysfunction by enhancing vascular smooth muscle relaxation.
OBJECTIVE The aim of this study was to investigate the effects of local injection of tadalafil in enhancing axial-pattern skin flap survival in rats.
MATERIALS AND METHODS Twenty Sprague-Dawley rats were used and a McFarlane-type caudally based axial-pattern skin flap was designed on the dorsum of the rat (2 × 9 cm). Rats were divided into two groups: the treatment group and the control group. Tadalafil 10 mg/kg/day was injected to the distal flap area of the treatment group for 3 days, and normal saline was injected for the control group. On Postoperative Day 7, necrotic flap area was measured and compared, and angiograms of the skin flaps were obtained in the two groups.
RESULTS In the treatment group, the mean necrotic area was 21.9±6.4%, and in the control group, 37.7±5.9%. There was a statistically significant increase of skin flap survival in the treatment group ( p =.001). Angiography also showed vasodilation of the choke vessels between adjacent angiosomes to form true anastomosis in the treatment group.
CONCLUSION The results demonstrate that the use of local injection of tadalafil to failing skin flaps increases the survival of axial-pattern flaps in rats.     

Effect of surgical denervation on the viability of inferior epigastric neurovenous flaps in the rat

The purpose of this study was to examine how the inferior epigastric neurovenous flap in the rat reacts to surgical denervation. The survival of a denervated flap was compared with that of an innervated flap. A 2 x 2-cm flap was raised in 30 female Wistar rats assigned randomly to six groups of 10 rats each: group 1, innervated neurovenous flap; group 2, denervated neurovenous flap, acute model; group 3, denervated neurovenous flap, chronic model; group 4, innervated inferior epigastric island flap; group 5, denervated inferior epigastric island flap, acute model; and group 6, control, composite graft. Acute denervation produced a significant decrease in the survival of the inferior epigastric neurovenous flap (p < 0.05). The surviving area of the innervated flaps decreased from 94+/-14% (mean +/- standard deviation) to 16+/-34% by acute denervation. Chronic denervation was effective in decreasing flap necrosis in these flaps (survival, 99+/-5%). There were no differences between the average viable area of the standard inferior epigastric flap in the denervated and innervated groups.     

Prospective evaluation of outcome measures in free-flap surgery

Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +/- 29 min) and in those that survived (92 +/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.     

Comparison of flash lamp pulsed-dye laser (585 nm) and conventional surgery in the delay of random dorsal rat flaps.

BACKGROUND AND OBJECTIVE: Delay is a basic surgical technique used by flap surgeons to improve the blood supply to the distal parts of a random skin flap. The aim of this study was to determine whether a scarless delay can be done by the use of the flash lamp pulsed-dye laser operating at a wavelength of 585 nm. STUDY DESIGN/MATERIALS AND METHODS: The pilot study showed that 6 J/cm(2) had a selective photothermolysis effect and therefore was chosen for testing the delay procedure on 15 rats. The percentage of flap necrosis of this group was compared to the results of 15 rats that underwent delay by surgery and 15 rats that were not treated prior to flap surgery (control group). RESULTS: Laser delay of McFarlane flaps resulted in an average of 15.5% smaller necrotic area compared to the control group (52.7% +/- 14.4% and 68.2% +/- 9.6%, respectively, P < 0.01) and was as effective as surgical delay (53.3% +/- 13.6%). CONCLUSIONS: The results indicate that the flash lamp pulsed-dye laser operating at 585 nm is effective for delaying cutaneous flaps in the rat model.     

Effect of topical nitroglycerine on the survival of ischemic flow-through venous flaps in rabbits

The purpose of this study was to investigate the effect of transdermal nitroglycerin on the survival of an ischemic one-vein flow-through venous flap (FTVF) model in the rabbit ear. Fifteen New Zealand white male rabbits were randomly divided into three groups: Group 1 (n = 5, 10 flaps)- no dressing on the operative wound; Group 2 (n = 5, 10 flaps)-occlusive film dressing group [polyurethane semipermeable membrane (Op-Site)]; and Group 3 (n = 5, 10 flaps)- transdermal nitroglycerine pad (Novartis-Nitroderm TTS 5 mg) on the wound. Nitroderm TTS and the occlusive film dressing were changed daily postoperatively for 3 days. The percentage of the surviving area and the mean extent of the surviving area to the axial vein were calculated on the postoperative 14 (th) day. Necrotic and surviving areas of flaps were consistent with histopathologic findings. Group 3 (83 percent +/-10.46, 17.4 +/- 3.0 mm) had larger flap surviving areas and longer distances to the axial vein than Group 1 (60 percent +/-15.29, 11.8 +/- 4.3 mm) and Group 2 (58 percent +/-10.25, 12.8 +/- 2.8 mm). The difference was statistically significant ( p < 0.05). This study demonstrated that postoperatively applied transdermal nitroglycerine significantly increased the ischemic FTVF survival area and the survival width to the axial vein.     

肘后外侧区动脉网在跨区互蒂轴型皮瓣中的意义

目的　探讨肘部动脉吻合网对于上肢轴型皮瓣扩大切取的意义。方法　选取 2 7侧新鲜成人尸体上肢制成 ABS铸型标本 ,逐层腐蚀、即时观察肘后、肘外侧区动脉吻合网的血供来源、分布 ,观测吻合血管的数量和总截面积 ,并与肘前区及肘内侧区进行比较。结果　肘后区的吻合支数量达 (8.6 4± 2 .74)支 ,截面积(0 .48± 0 .11) m m2。肘外侧区吻合支为 (8.30± 1.19)支 ,截面积 (0 .37± 0 .0 3) mm2。具有丰富的动脉吻合网。结论　肘后、肘外侧区具备桥接臂部与前臂之间的跨区互蒂轴型皮瓣的能力