缺氧缺血型狭长窄蒂皮瓣成活过程中SDF-1表达的实验研究

目的 检测基质细胞衍生因子-1( stromal cell derived factor1,SDF-1)在缺氧缺血型狭长窄蒂皮瓣组织不同时间、不同面积的表达,研究SDF-1/CXCR4轴在狭长窄蒂皮瓣组织血管新生中的作用.方法 在5头家猪双侧背部均制作蒂部长宽比例为4:2,携带面积分别为2 cm ×2 cm(A组皮瓣)、3 cm × 3 cm(B组皮瓣)、4 cm×4 cm(C组皮瓣)、5 cm × 5 cm(D组皮瓣)和6 cm ×6 cm(E组皮瓣)的狭长窄蒂皮瓣模型.对5组皮瓣进行大体观察、成活面积计算、皮瓣组织HE染色,用ELISA法检测皮瓣组织远端在术中及术后3、5、7、14 d时SDF-1表达变化情况.结果 ①同一组狭长窄蒂皮瓣,随着时间推移,SDF-1的表达也随之增加,在第5天达到最高值,随后逐渐下降,趋于基础水平.②不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1的表达也随之增加,当皮瓣面积达5cm×5 cm时,SDF-1的表达量不再增加,皮瓣远端部分坏死.结论 SDF-1的表达量可能与狭长窄蒂皮瓣成活过程中的供血量相关.     

乒乓球拍样皮瓣成活过程中基质细胞衍生因子-1、CD34的表达

目的 检测基质细胞衍生因子-1(SDF-1)、CDM在乒乓球拍样皮瓣组织不同时间、不同面积的表达,观察SDF-1在皮瓣组织血管新生中的作用.方法 制作乒乓球拍样皮瓣动物模型.对皮瓣进行大体观察、皮瓣成活情况、免疫组织化学及酶联免疫吸附试验(ELISA)技术检测皮瓣远端组织在术后0、3、5、7、14 d时SDF-1、CD34的表达.结果 (1)同一组狭长窄蒂皮瓣,随着时间推移,SDF-1、CD34的表达也随之增加,SDF-1在第5天达到最高值(A组124.80±4.05,B组137.85±3.03,C组166.53±2.98,D组72.80±2.63,E组62.79±2.20),CD34在第7天达到最高值(A组16.76±0.62,B组17.60±0.72,C组18.48±0.55,D组12.70±0.60,E组11.51±0.70),随后逐渐下降.(2)不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1、CD34的表达也随之增加,当皮瓣面积达5 cm×5 cm时,各项指标不再增加,皮瓣远端部分坏死.结论 在皮瓣成活过程中SDF-1和CD34的表达呈正相关.

Abstract：

Objective To detect the expression of stromal cell-derived factor 1 (SDF-1), CD34 in the PingPong Racket flap during the survival process, and investigate the role of SDF-1 in flap neovascularization. Methods The PingPong Racket flap animal model was established. The morphology and survival of the flap were observed. The expression of SDF-1 and CD34 in the distal flap was detected by using immunohistochemistry and enzyme-linked immunosorbent assay at 0, 3, 5, 7, and 14 days after operation respectively. Results (1) In the same group of flaps, with prolongation of time, the expression of SDF-1 and CD34 was increased. The expression of SDF-1 reached the peak at the 5th day (group A; 124. 80 ±4.05, B: 137.85±3.03, C: 166.53±2.98, D: 72. 80 ±2.63, E: 62.79±2.20), and that of CD34 reached the peak at the 7th day (group A: 16. 76 ±0.62, B: 17. 60 ±0.72, C: 18.48 ±0.55, D: 12.70 ±0. 60, E: 11. 51 ±0. 70) ; (2) In the different groups of flaps, when the flap area was increased, the expression of SDF-1 and CD34 was increased, and at the area of 5 cm ×5 cm, the flaps had partial necrosis. Conclusion There was a positive relationship between SDF-1 and CD34 in the survival process of the flap.     

一氧化氮合酶和CD34在狭长窄蒂随意型皮瓣中表达与皮瓣成活的关系

目的通过在猪背部设计一定宽长比例的狭长窄蒂所携带不同大小的几组随意型皮瓣,在术后不同时间测定各组皮瓣内一氧化氮合酶（nitri coxide synthase,NOS）和CD34的表达量,并观察皮瓣的成活面积,揭示NOS、CD34表达量与皮瓣成活的关系,以探讨狭长窄蒂皮瓣的成活机制。方法在5只白色实验猪的两侧背部均形成蒂部宽长比皆为2：4的狭长窄蒂皮瓣各5个,其面积分别为2cm×2cm、3cm×3cm、4cm×4cm、5cm×5cm、6cm×6cm,并依次命名为A、B、C、D、E皮瓣。其中A瓣为对照瓣。术后对皮瓣进行大体观察,并分别于术中即刻、术后3、5、7、14d切取皮瓣远端外侧缘组织块,用于测定皮瓣内NOS、CD34表达量,术后14d计算皮瓣存活面积。结果A、B、C组皮瓣NOS、CD34的表达量随皮瓣面积的增大逐步升高,皮瓣完全存活（P〈0．05）;D、E组皮瓣当皮瓣面积达到一定限度时,NOS、CD34表达餐不再随皮瓣面积的增大而升高,表达相对恒定,皮瓣远端部分坏死（P〉0．05）。结论任意型皮瓣的成活与蒂的宽长比没有直接关系。一定宽长比例的狭长窄蒂所携带的随意皮瓣成活面积有其一定限度。     

一定长宽比狭长窄蒂与任意皮瓣成活面积关系的实验研究

目的 揭示具有一定长宽比例的狭长窄蒂与任意皮瓣成活面积关系. 方法 25头猪被随机分成5组,每组5头,5组皮瓣蒂长宽比分别为0 cm:2 cm、1 cm:2 cm、2 cm:2 cm、3 cm:2 cm、4 cm:2 cm,每个长宽比例的狭长窄蒂均携带5个不同面积的任意皮瓣,分别为2 cm×2 cm、3 cm×3 cm、4 cm×4 cm、5 cm×5 cm和6 cm×6cm,并依次命名为A、B、C、D、E,其中A瓣为B、C、D、E瓣的对照瓣,在每组每只猪的双侧背部均形成A、B、C、D、E皮瓣,顺序随机排列.对每组皮瓣进行大体观察、荧光色素钠染色、ECT血流测定、成活面积分析等. 结果 ①当狭长窄蒂的长宽比例一定时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定界限时皮瓣远端即发生坏死,而成活面积并未缩小;②当皮瓣大小一定,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定界限时皮瓣远端即发生坏死,皮瓣成活面积缩小. 结论 任意皮瓣的蒂部可以设计成狭长状,蒂宽可远远小于瓣宽;一定长宽比的狭长窄蒂所能携带的任意皮瓣成活面积有其最大值,一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

地拉罗司对成年大鼠狭长窄蒂皮瓣DLL4、CD105表达及血管新生的影响

目的 探讨地拉罗司对成年大鼠狭长窄蒂皮瓣Delta样配体4(DLL4)、CD105表达及血管新生的影响.方法 健康成年SD大鼠20只随机分为地拉罗司组和对照组(n=10).地拉罗司组每只大鼠采用地拉罗司100 mg·kg-1·d-1连续灌胃1周,对照组采用等量生理盐水连续灌胃1周.灌胃停止后,两组每只大鼠背部左右各设计1个蒂部为1 cm×1 cm、瓣部为3 cm×3 cm的狭长窄蒂乒乓球拍样随意型皮瓣模型.手术1周后分别取各个皮瓣蒂部、皮瓣部中间位置组织1 cm×1 cm,以10％甲醛溶液固定,免疫组织化学(SABC法)分别检测CD105和DLL4.结果 地拉罗司组与对照组相比,无论在蒂部或是在皮瓣部,大鼠皮瓣组织内CD105标记的新生血管均增多,DLL4表达的新生血管均减少.两组中,皮瓣部组织中CD105、DLL4标记的新生血管均多于蒂部.结论 地拉罗司促进狭长窄蒂皮瓣中的CD105表达、促进血管新生,并且可能与其抑制皮瓣Notch途径中关键蛋白DLL4的表达有关.     

猪狭长窄蒂随意型皮瓣蒂部不同长宽比例与成活面积关系的研究

目的 探讨狭长窄蒂随意型皮瓣蒂的长宽比例与皮瓣成活面积的关系,为临床应用狭长窄蒂皮瓣提供理论依据.方法 将25只猪随机分成5组,每组5只,5组皮瓣蒂的长、宽比分别为0∶2,1∶2,2∶2,3∶2,4∶2,每个长宽比例的狭长窄蒂均携带5个不同面积的随意型皮瓣,分别为2 cm×2 cm、3 cm×3 cm、4 cm×4 cm、5 cm×5 cm、6 cm×6 cm,并依次命名为A、B、C、D、E,其中A瓣为B、C、D、E瓣的对照瓣,在每组每只猪的双侧背部均形成A、B、C、D、E皮瓣,顺序排列但两侧背部相反.对每组皮瓣进行大体观察、荧光色素钠染色、ECT血流测定、病理学表现和成活面积分析等.结果 ①狭长窄蒂随意型皮瓣和常规随意型皮瓣的成活过程和病理过程是一致的,皮瓣的成活过程并未因蒂部变窄变长而延缓.②当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定界限时皮瓣远端即发生坏死,而成活面积并未缩小.③当皮瓣大小不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定界限时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 ①随意型皮瓣的蒂宽可远远小于瓣宽,蒂宽和瓣长比可远小于传统的比例.②随意型皮瓣的蒂部可以设计成狭长状,使整个皮瓣形似"乒乓球拍",更利于皮瓣的旋转.③不同长宽比的狭长窄蒂所能携带的随意型皮瓣成活面积有其最大值,一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.

Abstract：

Objective To explore the relationship between the ratio of length to width of slender narrow pedicle and random flap survival area, and to provide a theoretical basis for the clinical application of slender narrow pedicle flaps. Methods 25 pigs were randomly divided into 5 groups, 5 pigs in each group. The ratio of length to width of slender narrow pedicle in 5 groups respectively was: 0∶2 , 1∶2 ,2∶2, 3∶2, 4∶2 . Every ratio's slender narrow pedicle was carrying five different size of random flaps,which were2cm×2cm(A),3 cm×3 cm(B),4 cm×4 cm(C), 5 cm×5 cm(D),6 cm×6 cm(E),respectively. Flap A was control flap. In each group, flap A, B, C, D and E were created in each pigs'bilateral back. The order in both sides back is contrary. The flaps were evaluated with the general observation, fluorescence examination, blood flow ECT test, pathological expression and computerized analysis of survival area. Results ① The living process and pathologic process of traditional flap and slender narrow pedicle flap were consistent. It could not postpone the flap living process when the flap pedicle became long and narrow. ② When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area , the distal flap would necrosis, the flap survival area would not reduce. ③ When the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would necrosis, the flap survival area would reduce.Conclusions ① Pedicle width of random flap can be much smaller than flap width. The ratio of pedicle width to flap length is far less than traditional ratio. ② The pedicle of random flap can be designed as slender shape, so that the whole flap looks like "pingpang bat ", which makes the narrow pedicle flap rotate easily. ③ A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flapsize or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.     

狭长窄蒂皮瓣在老年人皮肤癌治疗中的应用

目的 探讨狭长窄蒂皮瓣在老年肿瘤切除后软组织缺损修复中的应用及成活机制.方法 设计蒂部位于肿瘤切除后创面旁沿知名或穿支血管走向的狭长窄蒂皮瓣,用于老年人肿瘤切除后软组织缺损的修复.皮瓣切取最大面积12 cm×10 cm,最小3 cm×4 cm,蒂宽1.0～1.5 cm,蒂长2～8 cm.结果 共17例,14例Ⅰ期成活,外形良好,3例因早期包扎不当,延迟愈合.结论 老年人皮肤组织细胞代谢率低,移植后皮瓣组织本身的耐缺血缺氧能力强,设计狭长窄蒂皮瓣修复老年肿瘤切除后软组织缺损,较易成活,且窄蒂狭长,转移容易,皮瓣不臃肿,同时利于肿瘤的早期综合治疗,是老年肿瘤术后修复较理想方法.     

狭长窄蒂皮瓣在面额部皮肤癌治疗中的应用

目的 介绍一种打破常规任意皮瓣长宽比例限制的狭长窄蒂皮瓣在面额部皮肤癌切除后组织缺损修复中的应用,并探讨其成活机制.方法 设计不带知名血管,以耳前或耳后狭长皮肤筋膜或单纯筋膜为蒂的侧颌颈部皮瓣,修复面额部皮肤癌切除后组织缺损26例,其中颞额区皮肤基底细胞癌5例,皮肤鳞状细胞癌6例,面部恶性黑色素瘤1例,基底细胞癌8例,鳞状细胞癌5例,皮肤黏液癌1例.26例皮瓣的蒂部有24例在耳前,2例在耳后;4例仅为筋膜蒂.皮瓣最大10.0 cm×8.0 cm,最小3.0 cm×2.5cm,蒂宽1.0～1.5 cm,蒂长2～6 cm.结果 26例狭长窄蒂皮瓣除5例皮瓣远端淤血,其后渐恢复,其余全部成活,修复后局部外形理想.结论 该狭长窄蒂皮瓣不带知名血管,其长宽比例超过常规任意皮瓣,无需解剖血管,切取容易,蒂部狭长使其旋转和覆盖范围大,供、受区邻近,是修复面额部皮肤癌扩大切除后组织缺损的理想皮瓣.     

猪背部乒乓球拍样任意型皮瓣成活的动物实验研究

目的 探讨乒乓球拍样任意型皮瓣成活面积与窄蒂长宽比例关系.方法 25只猪随机分成5组,在5组猪的背部分别形成不同长宽比例的狭长窄蒂和5个不同面积的任意型皮瓣.对每组皮瓣进行大体观察、荧光色素钠染色、单光子发射计算机断层仪（ECT）血流量测定、成活面积分析等.结果 当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定限度时皮瓣远端即发生坏死,而成活面积并未缩小;当皮瓣面积不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定限度时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 狭长窄蒂任意型皮瓣是一种简便实用的任意型皮瓣,蒂部可以设计成狭长状,蒂瓣的长宽比远小于传统的比例,在一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

改良窄蒂邻指皮瓣修复示指、小指中远节创面

目的探讨改良窄蒂邻指皮瓣修复示指、小指中远节较大刨面的可行性及实用性。方法采用包含指动脉背侧终末支为窄皮蒂的改良邻指皮瓣修复示指、小指皮肤缺损28例（可切取支配皮瓣的指固有神经指背支与创面内指固有神经残端吻合重建感觉）,示指、小指掌侧创面25例,示指、小指远节背侧创面分别2例、1例。皮瓣范围：最小1．8cm×2．2cm,最大4．5cm×2．3cm。吻合神经3例。结果所有皮瓣、植皮均成活良好,外观佳、无需修形,吻合神经的3例感觉恢复约S3,其余未吻合神经者恢复保护性感觉。结论窄蒂邻指皮瓣是一种简便快捷、经济有效、安全可靠、易于推广、可重建感觉的修复示指、小指中远节较大创面的较佳术式。     

重组腺病毒介导的血管内皮生长因子165基因增强大鼠横形腹直肌肌皮瓣活力的研究

目的探讨重组腺病毒介导的血管内皮生长因子165(adenovirusmediatedvascularendothelialgrowthfactor165,Ad-VEGF165)基因,增强大鼠横形腹直肌肌皮瓣(transverserectusabdominismusculocutaneousflap,TRAM)局部缺血区域活力的基因治疗。方法SD大鼠30只,制备30mm×80mm以下腹部血管作为血管蒂的右侧矩形TRAM皮瓣,随机平均分成5组,分别在大鼠TRAM皮瓣皮下、皮下+腹直肌及腹直肌局部注射Ad-VEGF165(1～3组:治疗组),同时在TRAM皮瓣皮下+腹直肌局部注射重组腺病毒载体介导的绿色荧光蛋白(adenovirusmediatedgreenfluorescentprotein,Ad-GFP,4组:重组腺病毒自身对照组)和DMEM培养液(5组:空白对照组),于注射后第7天手术,术后第7天检测各组大鼠TRAM皮瓣成活面积、CD34微血管密度(microvasculardensity,MVD)、VEGF免疫组织化学染色和原位杂交组织化学(insituhybridizationhistochemistry,ISHH)。结果11～3组TRAM皮瓣成活面积分别为14.19±2.77、15.18±2.18、8.30±1.28cm2,均较4、5组4.12±1.86、3.60±1.95cm2明显增加,且差异有统计学意义(P<0.05);21～3组TRAM皮瓣CD34MVD均高于4、5组,差异有统计学意义(P<0.05);31～3组VEGF免疫组织化学染色和ISHH呈阳性表达。结论重组腺病毒载体介导的VEGF165基因局部注射,能增加大鼠TRAM皮瓣局部缺血区域成活面积。     

Effect of hyperbaric oxygen therapy on the tubed pedicle flap survival in a rat model

The effect of hyperbaric oxygen therapy (HBO) on survival of the distal skin paddle with early pedicle division was studied in a rat tubed pedicle flap model. In part 1, tubed pedicle skin flaps were created on the backs of 14 rats. The pedicle of each skin flap was divided at intervals of 3, 4, 5, and 7 days, and the survival area of each distal skin paddle was measured 5 days after each pedicle was divided. The results showed that the percentages of survival were 0%, 29.9%, 89.9%, and 100% at 3, 4, 5, and 7 days, respectively. In part 2, the tube flaps were created on the backs of 28 rats. The tubed pedicles were divided 4 days after creation. In the experimental group 1 (n = 9), the rats received HBO treatment at 2 atm of pressure twice daily for 3 consecutive days before pedicle division. In the experimental group 2 (n = 9), the rats received HBO treatment after pedicle division twice daily for 3 consecutive days. In the control group (n = 10), the rats received no HBO treatment. The results showed that the mean survival area of the distal skin paddle at 5 days after pedicle division for the groups treated with HBO before and after pedicle division was 6.31 +/- 2.69 cm2 (69.19%) and 6.12 +/- 1.52 cm2 (71.22%), respectively. These survival rates were of statistical significance as compared with the survival rates in the control group of 2.70 +/- 1.89 cm2 (27.9%). These results demonstrate that the administration of HBO therapy to the animal with a tubed pedicle flap can increase flap survival with early division of the tubed pedicle.     

结扎伴行静脉对逆行岛状皮瓣存活的影响

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3 cm×3 cm,血管蒂长4 cm,血管蒂周围保留1 cm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.

Abstract：

Objective To evaluate the effect of ligating venae commutantes in the pedicle on the survival of reverse-flow island flaps. Methods Ten New Zealand rabbits were used. Reverse flow island flap based on the saphenous artery and vein was created on both hind limbs,with a total of 20 flaps. The size of the flap was 3 cm×3 cm with a 4 cm long vascular pedicle containing 1 cm 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 venae commutantes) was raised and its sheath was not disturbed,maintaining communicating and collateral branches intact. In group Ⅱ,the 2 venae commutantes were ligated with 8-0 suture at both ends of the pedicle under 10X microscope and the connective tissue was maintained intact. The color and congestion of flaps were observed daily. Flap survival rate was measured after one week. The vascular pedicle was harvested and observed histologically. Results The flaps began to appear obviously swelling after blood oozing stopped. The extent of swelling was more severe in group Ⅱ than in group Ⅰ. Flap survival rate of group Ⅰ (92.7±12.1)% was significantly higher than that of group Ⅱ (46.8±38.3)% (t=3.61,P<0.01). Histological examination revealed lots of dilated venules in the vascular pedicle. The amount of dilated venules in group Ⅱ was more than that in group Ⅰ. Lots of thrombi could be seen 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.     

低分子肝素钠在远端蒂筋膜皮瓣中的应用

目的 探讨应用低分子肝素钠以减少皮瓣内静脉血淤滞,提高皮瓣存活质量的效果.方法 自2007年3月至2009年6月,应用拇指桡背侧远端蒂皮神经筋膜皮瓣修复拇指创面13例,皮瓣面积1.7 cm×2.0 cm～3.0 cm×4.5 cm,蒂长1.5～3.0cm.按手术先后顺序分为2组,术后A组给予常规处理,B组加用皮下注射低分子肝素钠5000 U,每日1次,共5 d.术后观察皮瓣血液循环情况.结果 两组皮瓣早期血液循环良好.A组术后1～2 d创面渗血停止后,3例出现明显的肿胀,皮瓣远端部分颜色暗紫,经拆除部分缝线,皮瓣全层切开,挤压擦拭至有暗红色静脉淤血渗出后,皮瓣颜色逐渐转为红润,经多次反复处理后皮瓣存活;其余皮瓣存活良好.B组皮瓣的渗血时间及渗血量明显增加,未出现静脉危象,所有皮瓣均存活且质量高.术后随访3周至2个月,皮瓣颜色和周围皮肤基本一致,质地较软,拇指活动功能满意.结论 皮下注射低分子肝素钠能延长远端蒂皮瓣术后渗血时间,减轻皮瓣静脉回流的负荷,提高皮瓣存活质量.     

小腿前外侧岛状皮瓣修复胫骨外露的解剖研究与临床应用

目的 探讨小腿前肌间隔动脉链为蒂的岛状皮瓣修复胫骨外露的术式及手术方法.方法 40侧成人尸体下肢标本经动脉灌注红色乳胶,4侧新鲜成人尸体下肢标本动脉造影,观测小腿前肌间隔内的胫前动脉穿支与腓动脉终末前穿支的位置、走行、外径及相互吻合.临床应用小腿前外侧岛状皮瓣转位修复胫骨外露11例.男7例,女4例;年龄20～59岁,平均36岁.结果 40侧标本腓骨长度为(32.3±2.4)cm.胫前动脉发出腓浅动脉、胫前动脉下段前肌间隔穿支,与腓动脉终末前穿支在小腿前肌间隔内相互吻合,形成动脉链,这三条动脉外径分别为(1.4±0.4)mm、(1.0±0.4)mm及(1.5±0.4)mm,动脉链吻合处外径为(0.6±0.2)mm.动脉链伴腓浅神经走行,营养神经和小腿前外侧皮肤.临床应用小腿前外侧岛状皮瓣修复胫骨外露的11例中,以胫前动脉下段前肌间隔穿支为蒂2例,以胫前动脉下段前肌间隔穿支的升支为蒂3例,以胫前动脉下段前肌间隔穿支的降支为蒂3例,以腓动脉终末前穿支升支为蒂3例.皮瓣切取面积7 cm×5 cm～13 cm×5 cm.随访1～3年,平均1.5年,11例皮瓣全部成活,无破溃、臃肿.结论 根据皮肤缺损部位、面积等灵活选用小腿前肌间隔内动脉链为血管蒂,设计前外侧岛状皮瓣修复胫骨外露,术式灵活,是修复胫骨外露的理想皮瓣.

Abstract：

Objective To explore surgical methods of repairing tibial skin defect using the anterolateral crural island flap.Methods The location,external diameters,anastomosis and distribution of perforators from the anterior tibial artery and the peroneal artery in the anterior septum were observed in 40 cadaveric specimens.Arterial angiography was performed in 4 fresh legs.Clinically,11 cases with tibial skin defect were repaired with the anterolateral crural island flap.There were 7 males and 4 females,with an average of 36 years (20-59 years).The area of the skin defect ranged from 6 cm×4 cm to 12 cm×4 cm.Results An arterial chain was formed by the interconnection of the superficial peroneal artery,the anterior septocutaneous perforator from distal part of the anterior tibial artery and the anterior end-perforator of the peroneal artery.It ran in the anterior septum and went along with the superficial peroneal nerve to supply blood to adjacent fascia and skin.The external diameters of the three perforators were (1.4±0.4) mm,(1.0±0.4) mm and (1.5±0.4) mm respectively,and the external diameter of the arterial chain was (0.6±0.2) mm.Clinically,we designed 4 methods to repair 11 cases of tibial skin defect successfully with the anterolateral cnnal island flap.The anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 2 cases;ascending branch of the anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 3 cases;descending branch of the anterior septocutaneous perforator from distalpart of the anterior tibial artery was used as pedicle in 3 cases;ascending branch of the anterior end-perforator of the peroneal artery was used as pedicle in 3 cases.The area of the flaps ranged between 7 cm×5 cm and 13 cm×5 cm.All patients were followed up with a mean time of 1.5 years.All flaps survived totally without diabrosis and swelling.Conclusion The anterolateral island flaps pedicled with perforators arising from the anterior septum of the lower leg is a good choice for surgeons to repair tibial skin defect.     

改良封闭负压引流技术在腹部皮瓣供瓣区的临床应用

目的：探讨改良封闭负压引流（vaccLlm sealing drainage,VSD）技术在腹部皮瓣供瓣区应用的临床效果。方法：选择2010年2月-2012年1月期间行腹部皮瓣修复手或上肢创面的患者14例,创面大小为15cm×10cm-9cm×5cm。创面清创后行腹部随意皮瓣转移,皮瓣长宽比例在2：1以内,面积15cm×12cm-9cm×7cm。供瓣区及皮瓣蒂部裸露区应用医用海绵覆盖,医用半透性粘贴薄膜封闭整个术区。连接负压吸引装置,腹带固定患肢。术后第2天,在医用海绵的远端,刺入静脉输液针,每天500ml生理盐水持续进行灌洗。皮瓣移植14-18天后行皮瓣断蒂术,术后10-12天切口拆线。结果：所有病例皮瓣全部成活,切口甲级愈合13例,乙级愈合1例。9例患者供瓣区通过局部皮瓣转移后,直接缝合,未予植皮。4例患者行局部部分拉拢缝合,缩小创面后,移植皮片覆盖。植皮面积8cm×5cm-5cm×3cm。无VSD装置更换病例。3例患者术后3天出现负压引流区轻度疼痛。其余患者无不适反应。所有病例静脉输液针穿刺孔未发生可见漏气现象,未影响负压引流的正常进行。结论：改良VSD技术延长了VSD装置的使用时间,明显减少了VSD的并发症;改良VSD技术减少了腹部供瓣区的植皮率,降低了术区感染率,简化了腹部皮瓣手术过程。