微型岛状皮瓣在手部创面修复的临床应用

目的探讨各种微型岛状皮瓣在手部创面修复中的临床效果。方法对259例341块手部创面,临床应用10种微型岛状皮瓣修复。皮瓣面积最大为6 cm×4 cm,最小为2 cm×1 cm。结果皮瓣成活324块,失活17块。术后211例得到随访1～15年,皮瓣外形及功能恢复满意者192例(91%),不满意者19例(9%)。结论根据手部创面选择合适的微型岛状皮瓣,术后功能恢复及外观较满意。     

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.     

地塞米松对阻断静脉的岛状皮瓣缺血再灌注损伤的保护作用

目的：寻求对岛状皮瓣阻断静脉回流致致血再灌注损伤的有效保护药物。方法：采用大鼠岛状皮瓣缺血再灌注损伤模型,观察治疗组与对照组皮瓣皮活率。组织形态学改变。结果：对照组静脉阻断8h皮瓣大部分坏死,而地塞米松治疗组则可明显延长皮瓣耐受静脉阻断,时间,再灌注8h内给药均可起良好的保护性作用,地塞米松5mg/kg保护效果最佳,再增加剂量并不能进一步提高皮瓣保护效果。结论：地塞米松对阻断皮瓣静脉回流所致的岛状皮瓣缺血再灌注损伤有良好的保护性作用。     

吻合浅静脉的掌背动脉岛状皮瓣

目的：采用吻合皮瓣浅静脉方法，解决掌背动脉逆行岛状皮瓣静脉回流不畅，疗效满意。方法：在切取掌背动脉逆行岛状皮瓣时，保留皮瓣远端一段轴行掌背浅静脉，随皮瓣逆行翻转后将静脉反折吻合于掌背静脉网上。结果：自１９９０年８月～１９９５年１月，共治疗１２例。术后皮瓣全部成活，仅３例皮瓣发生张力性水泡。结论：本术式有效地解决了掌背皮瓣逆行翻转后静脉回流不畅的问题。     

中环指岛状皮瓣、示指背侧岛状皮瓣转移修复拇指损伤

目的 评价中环指岛状皮瓣和（或）示指背侧岛状皮瓣转移修复拇指损伤的疗效。方法 １９８９年７月￣１９９８年１１月共８例拇指损伤应用中环指岛状皮瓣和（或）示指背侧岛状瓣修复。其中示指侧同状皮瓣转移修复拇指损伤２例,中指尺侧岛状皮瓣加示指背侧岛状岛状皮瓣转移修复拇指脱套伤１例,中环指双岛状皮瓣转移修复拇指撕脱离断伤１例。中指尺侧岛状皮拇指损伤４例。随访７个月－９年１１个月,平均５年１个月,主要观察皮     

指背筋膜蒂逆行岛状静脉皮瓣修复甲床缺损

手指甲床缺损临床缺乏满意的修复手段,多采用甲床移植、全厚植皮、瘢痕愈合或吻合血管的趾甲瓣移植的方法进行治疗.本院自2001年3月至2002年12月,采用指背筋膜逆行岛状静脉皮瓣Ⅰ期修复甲床缺损7例,获得满意疗效.报告如下.     

The venous flap

Venous flaps are flaps vascularized through the venous network located within them; they can either be perfused by venous blood or by the rerouting of the arterial blood through the venous bed of the flap. Experimental research has been conducted on various animal models to study the viability, mechanism of survival, and perfusion physiology of venous flaps. Many surgeons have successfully used venous flaps clinically for emergency wound closure or in planned operations. They can be used with almost the same indications as for the customary fascio-cutaneous and skin flaps, and they have the great advantage of preserving the artery in the donor site. Despite the advantages of using venous flaps, their clinical usage is still looked upon with considerable skepticism. Further research into their use is definitely necessary. In this paper, in order to provide reference material for investigators, the authors review the classification, methods of investigation and experimental designs, and discuss the survival mechanisms of venous flaps. Received: 30 December 1998 / Accepted: 15 September 1999     

The superficial temporal venous island flap for eyebrow reconstruction

A case in which a venous island flap was used for eyebrow reconstruction is presented. This flap was based on the anterior superficial temporal vein.     

指背静脉动脉化逆行岛状皮瓣修复指端缺损

目的 介绍一种修复指端缺损的新方法。方法 指背逆行岛状皮瓣通过指端的指动脉与其静脉吻合,形成静脉动脉化皮瓣修复指端缺损10例。结果 所有皮瓣均成活,外形满意。结论 该方法易操作,需一定的显微外科基础,为修复指端缺损提供一种新方法。     

脂质体携载金属硫蛋白对皮瓣继发静脉缺血再灌注损伤的作用

目的 观察脂质体包裹金属硫蛋白(MT)对岛状皮瓣继发静脉缺血再灌注损伤的保护作用。方法 在大鼠下腹部岛状皮瓣继发静脉缺血再灌注损伤模型上测定皮瓣即刻、继发缺血再灌注30min、7d后的丙二醛(MDA)含量、髓过氧化物酶(MPO)活性，继发缺血再灌注30min时血浆内皮素(ET)、乳酸脱氢酶(LDH)水平，7d后皮瓣MT的含量。结果 脂质体携载MT组明显降低皮瓣MDA、MPO、血浆ET、LDH含量，增加7d后皮瓣组织MT含量，提高皮瓣成活率。结论 脂质体包裹MT对皮瓣继发静脉缺血再灌注损伤具有良好的保护作用。     

顺行岛状静脉皮瓣的临床应用

为达到修复肢体远端组织缺损时不损伤其主干动脉的目的,设计以浅静脉干远端为蒂的顺行岛状静脉皮瓣。临床应用6例,结果5例成活,1例坏死。结论认为静脉岛状皮瓣成活过程比较复杂,严格选择适应证,采用促活措施是此类皮瓣成活的关键。     

缺血再灌注损伤皮瓣组织中金属硫蛋白含量变化

目的　观察缺血再灌注损伤皮瓣组织中金属硫蛋白 (metallothionein ,MT)的含量变化。方法　 16只大鼠随机分为对照组 (n =8)和缺血再灌注损伤组 (n =8)。在大鼠腹壁浅血管为蒂的岛状皮瓣缺血再灌注损伤模型上 ,用10 9Cd血红蛋白饱和法和硫代巴比妥酸法测定皮瓣组织中MT及丙二醛(MDA)含量 ,比色法测定皮瓣组织过氧化物酶 (MPO )活性。结果　缺血再灌注损伤组在缺血 8h、再灌注 12h、2 4h时皮瓣组织中MDA水平分别较对照组高 41.7%、111.4%、13 5.7% ,MPO水平分别较对照组高 72 .1%、2 18.9%、2 96.0 % ,MT含量分别较对照组高 42 .6%、52 .8%、10 2 .3 % (P <0 .0 5或P<0 .0 1)。结论　皮瓣组织中MT含量增多 ,可能与皮瓣缺血再灌注损伤有关     

指背静脉动脉化逆行岛状皮瓣修复指端缺损

目的 介绍一种指端修复的新方法。方法 指背逆行岛状皮瓣通过指端的指动脉与皮瓣的静脉吻合形成静脉动脉比逆行岛状皮瓣修复指端缺损10例。结果 所有皮瓣均成活，外形满意。结论 方法易行，为指端修复增添了一种新的可供选择的方法，但需一定的显微外科基础。     

不同类型皮瓣缺血再灌注损伤中性粒细胞活化水平的对比研究

目的 研究中性粒细胞在阻断动脉供血及静脉回流皮瓣缺血再灌注损伤中不同活化水平。阐明阻断静脉回流皮瓣耐受缺血较阻断动脉供血皮瓣耐受缺血弱的原因。方法 在不同时间点取材。测量皮瓣髓过氧化物酶(MPO）含量；计数皮瓣蒂部血管活化中性粒细胞数量。结果正常皮瓣组MPO-直未测到，阻断动脉供血组再灌注4h后MPO开始增加，24h达到高峰；阻断静脉回流组再灌注4h时MPO开始增加，24h达到高峰。最高值是动脉供血组的1．5倍；蒂部血管内活化中性粒细胞数量，阻断静脉回流组明显大于阻断动脉供血组。结论阻断静脉回流组皮瓣中性粒细胞活化时间较阻断动脉供血组早，活化数量多。中性粒细胞活化程度的不同是导致阻断静脉回流组皮瓣耐受缺血较阻断动脉供血组弱的重要原因。     

顺行岛状静脉皮瓣的临床应用

为达到修复肢体远端组织缺损时不损伤其主干动脉的目的，设计以浅静脉干远端为蒂的顺行岛状静脉皮瓣。临床应用６例，结果５例成活，１例坏死。结论认为静脉岛状皮瓣成活过程比较复杂，严格选择适应证，采用促活措施是此类皮瓣成活的关键。