扩张预制对跨区供血轴型皮瓣的桥联效应

目的 探讨扩张预制对跨区血管构筑以及跨区供血轴型皮瓣成活率的影响,为提高跨区供血轴型皮瓣的成活率,以及开发新的跨区供血轴型皮瓣供区提供研究思路.方法 取12只成年健康五指山猪,体重20～30kg.实验分为A、B两部分,每部分6只,均采用双侧自身对照设计.实验A:每只动物随机取一侧为对照组,另一侧为扩张组,两侧以腹中线为界;对照组为侧腹壁形成的方形皮瓣,扩张组为扩张预制皮瓣.实验B:每只动物随机取一侧为扩张组,另一侧为延迟组;扩张组为扩张预制皮瓣,延迟组为单纯扩张器植入不扩张的延迟皮瓣.皮瓣制备后及时行皮瓣动脉造影,术后2周行皮瓣成活率测定.结果 实验A扩张组皮瓣动脉造影显示,扩张皮瓣旋髂深动脉和腹壁上动脉之间吻合支数量多,管径粗,旋髂深动脉和腹壁上动脉系统能清楚显影;对照组造影剂通过3～4条较细的吻合支到达腹壁上动脉终末支及终末穿支,腹壁上动脉系统大部分不能显影.实验B扩张组旋髂深动脉和腹壁上动脉间完全沟通,吻合支丰富,动脉口径较粗;延迟组造影剂通过少量不规则吻合支由旋髂深动脉达腹壁上动脉,但充盈不顺畅,充盈灌注范围较扩张组小,且动脉口径也小于扩张组.实验A扩张组及对照组皮瓣成活率分别为90.16%±3.61%及72.67%±5.35%;实验B扩张组及延迟组皮瓣成活率分别为92.08%±3.30%及80.79%±4.52%,组间差异均有统计学意义(P<0.01).结论 扩张预制能有效提高跨区供血轴型皮瓣的成活率,桥联效应为其主要作用机制.

BRIDGING EFFECT OF EXPANSION PREFABRICATION ON CROSSING AREA SUPPLY AXIAL PATTERN FLAP IN PIGS

OBJECTIVE: To explore the effects of tissue expansion on the anastomoses and the survival of the axial pattern flap with a crossing area supply so as to improve the survival of crossing area axial pattern flap and to provide a new idea for the development of original crossing area axial flap. METHODS: The experiment included two parts. Experiment A was divided into expansion group and control group. Square flaps were randomly designed on own control bilaterally in each animal with a boundary of midline. Experiment B was divided into expansion group and delay group. The flaps were also randomly designed on own control bilaterally. Angiographic analysis and gross survival observation were carried on. RESULTS: Experiment A: Angiography showed that there were abundant anastomoses with big caliber between deep iliac circumflex artery and superior epigastric artery in expansion group and there were only 3-4 anastomoses in control group. Experiment B: Angiography showed that there were abundant anastomoses with big caliber in expansion group and there were two arterial systems with relatively less anastomoses and smaller caliber in delay group. The survival rates in expansion group was significantly higher than that in the control group (90.16% +/- 3.61% vs 72.67% +/- 5.35%) in experiment A, and in experiment B the survival rate was 92.08% +/- 3.30% in the expansion group and 80.79% +/- 4.52% in the delay group, showing significant difference (P < 0.01). CONCLUSION: Expansion prefabrication can and improve the survival of the crossing area supply axial pattern flap. The mechanism is the bridging effect.