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.

The influence of vein ligation on the survival of reverse-flow island flaps: an experimental study in rabbits

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.