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。

Relationship between expression of NOS and CD34 and flap survival area in slender narrow pedicle flap

Objective To reveal the relationship between NOS,CD34 expression and the flap survival area,and to explore the survival mechanism of narrow strip flap,by designing different skin flaps with a slender narrow pedicle in a certain proportion of length to width on pigs' backs.Methods Five narrow flaps were formed on each side of the five white domestic pigs' back,of which pedicle width length ratio were 2 cm:4 cm,the area of the flaps was 2 cm × 2 cm,3 cm × 3 cm,4 cm ×4 cm,5 cm × 5 cm,and 6 cm × 6 cm,respectively,and named as flaps A,B,C,D,and E in turn.Besides,the flap A was taken as control.After the operation,the flaps were evaluated with general obveration,and NOS and CD34 expression and survival area were analyzed.Results For groups A,B and C flaps,the expression level of NOS and CD34 gradually elevated as the flap increased in size,and flaps completely survived (P＜0.05) ; For flaps in groups D and E,when distal end of flap was partial necrosis,the expression level of NOS and CD34 no longer elevated with the increase of skin flap area,and their expression was relatively constant (P＞0.05).Conclusions The survival area of the skin flaps is not in proportion to the width of its pedicle.Thus there is a maximum survival area of a skin flap carried by slender narrow pedicle in a certain proportion of length to width.