真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因…

为了探讨真皮下血管网薄皮瓣的成活机理，以兔为实验动物，在其背侧形成１５ｃｍ×３ｃｍ的真皮下血管网薄皮瓣，利用微循环显微镜，病理切片，组织化学染色等手段进行观察。结果表明真皮下血管网薄皮瓣术后远，中，近段血管构筑具有明显差别：近段同正常皮肤，中段为极度活跃的血管增生，远段为中度血管增长。     

真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因子的关系

为了探讨真皮下血管网薄皮瓣的成活机理,以兔为实验动物,在其背侧形成15cm×3cm 的真皮下血管网薄皮瓣,利用微循环显微镜、病理切片、组织化学染色等手段进行观察。结果表明真皮下血管网薄皮瓣术后远、中、近段血管构筑具有明显差别:近段同正常皮肤,中段为极度活跃的血管增生,远段为中度血管增生。皮瓣中段血管构筑的变化起一个“中介蒂”作用,是皮瓣能够早期断蒂及超过传统长宽比例可以成活的基础。成纤维细胞生长因子是促使皮瓣血管构筑变化的重要因素之一。     

真皮下血管网薄皮瓣血运重建方式的实验研究

目的 探讨真皮下血管网薄皮瓣的成活机理。方法 分别在３组家兔背部形成真皮下血管网薄皮瓣、真皮下血管网皮片、传统随意皮瓣。运用组织透明技术,观察３组动物术后１～７ｄ、１４ｄ血管构筑变化的差异。结果 真皮下血管网薄皮瓣段存在一血管增生快速密集区－“中介蒂”,其血运重建过程明显早于传统随意皮瓣、真皮下血管网皮片。结论 本研究证实了“中介蒂”的存在,且这是真皮下血管网薄皮瓣可早期断蒂、有一定限度超长成活的     

真皮下血管网薄皮瓣的自由基测定

以１２只猪为模型，在其两侧背部各制备真皮下血管网薄皮瓣，筋膜皮瓣和真皮下血管网皮片，长均１５ｃｍ，宽为３ｃｍ，各２４个，术后７天观察其成活长度，并取离蒂部４、８和１２ｃｍ处的以上三种皮瓣（片）的真皮下层组织行自由基测定。结果真皮下血管网薄皮瓣成活长度较筋膜皮瓣增加了３８％，分析了真皮下血管网膜皮瓣超长成活的因素之一是皮瓣内自由基产生较少。     

真皮下血管网薄皮瓣的自由基测定

以１２只猪为模型，在其两侧背部各制备真皮下血管网薄皮瓣、筋膜皮瓣和真皮下血管网皮片，长均为１５ｃｍ，宽为３ｃｍ，各２４个。术后７天观察其成活长度，并取离蒂部４、８和１２ｃｍ处的以上三种皮瓣（片）的真皮下层组织行自由基测定。结果真皮下血管网薄皮瓣成活长度较筋膜皮瓣增加了３８％。分析了真皮下血管网薄皮瓣超长成活的因素之一是皮瓣内自由基产生较少。     

真皮下血管网薄皮瓣的实验研究与临床应用

以１２只家猪为实验动物，对随意型真皮下血管网薄皮瓣及岛状真皮下血管网薄皮瓣的减薄层次、范围及其血供的可靠性进行研究。结果表明：随意型及岛状真皮下血网薄皮瓣减薄层次，在真皮下血管网的下方保留０．３ｃｍ脂肪和在真皮下血管网的下方保留１／３浅筋膜层，两种减薄层次的成活率无显著差异。随意型真皮下血管网薄皮瓣成活的长宽比例为２．５：１，术后６天可断蒂。岛状真皮下血管网薄皮瓣可减薄６０％～７０％。临床应用随意     

含脐旁血管蒂真皮下血管网薄皮瓣在手外伤的应用

１９９０年１０月至１９９１年９月，应用含脐旁血管蒂真皮下血管网薄皮瓣带蒂移植修复１１例手部挤压撕脱伤。最大皮瓣长２０ｃｍ，蒂宽６．５ｃｍ，远端宽１０．５ｃｍ，最小皮瓣长６．５ｃｍ，蒂宽２．５ｃｍ。除２例因热压伤伴感染的创面分析在术后９天和１１天断蒂外，其余均在５～７天断蒂。皮瓣成活良好。对本皮瓣的断蒂时间与优点进行了讨论。     

真皮下血管网皮瓣成活机理的实验研究

作者以家猪躯干部皮瓣为实验模型，研究了真皮下血管网皮瓣的血供方式及成活机理。采用成活长度、ＥＣＴ测定核素分布范围等方法证实，超长真皮下血管网皮瓣远侧部分得不到来自蒂部的血供，这种皮瓣实际上是真皮下血管网皮瓣与皮片的复合物，超长超宽真皮下血管网皮瓣实际上大部分不是皮瓣而是皮片。超长超宽真皮下血管网皮瓣的成活大部分依赖创面及创周血供，为皮片样成活。     

He—Ne激光对随意型真皮下血管网皮瓣远段血管重建的影响

为了探明激光对真皮下血管皮瓣血管重建有无影响，使用能量密度为３．１５Ｊ／ｃｍ＾２的Ｈｅ－Ｎｅ激光照射兔随意型真皮下血管网皮瓣远１／３段。皮瓣血管内灌注墨汁，用组织切片，图像分析等方法对此型皮瓣的成活及血管重建状况进行观察。结果表明，随意型真皮下血管网皮瓣早期血供范围受皮瓣长宽比例的限制，Ｈｅ－Ｎｅ激光照射可改善皮瓣的微循环，提高皮瓣成活率，主要原因是扩张了篾这，尤其以静脉为著；并能促进与创缘和基底     

He-Ne激光对随意型真皮下血管网皮瓣远段血管重建的影响

为了探明激光对真皮下血管皮瓣血管重建有无影响，使用能量密度为３．１５Ｊ／ｃｍ２的Ｈｅ－Ｎｅ激光照射兔随意型真皮下血管网皮瓣远１／３段。皮瓣血管内灌注墨汁，用组织切片、图像分析等方法对此型皮瓣的成活及血管重建状况进行观察。结果表明，随意型真皮下血管网皮瓣早期血供范围受皮瓣长宽比例的限制。Ｈｅ－Ｎｅ激光照射可改善皮瓣的微循环，提高皮瓣成活率，主要原因是扩张了血管，尤其以静脉为著；并能促进与创缘和基底部血管的吻合生长。     

Accelerating flap maturation by vascular endothelium growth factorin a rat tube flap model.

The effect of exogenous vascular endothelium growth factor (VEGF) on the survival of the distal skin paddle with early pedicle division was studied in a rat tubed pedicle flap model. In part I, tubed pedicle skin flaps were created on the backs of 14 rats. The pedicle was divided after an interval of 3, 4, 5 or 7 days, and the survival area of each distal skin paddle was measured 5 days after the pedicle was divided. The percentages of survival were 0, 24.9%, 89.9% and 100%, respectively. In part II, tube flaps were created in 20 rats. In the experimental group, 2 ml of VEGF (50 microg ml(-1)) was injected into the recipient bed during tube flap creation in each rat. In the control group, 2 ml of saline was given. The tubed pedicle was divided 4 days after creation. The mean survival area of the distal skin paddle in the group treated with VEGF was 7.32 +/- 1.36 cm(2) (80.91%) at 5 days after pedicle division, which was of statistical significance when compared with the survival in the control group of 2.70 +/- 1.89 cm(2) (27.9%). The histology showed angiogenesis at the skin paddle-recipient bed interface following VEGF injection. These results demonstrate that the subcutaneous administration of VEGF into the recipient bed of the tube flap transfer can induce angiogenes is at the junction between the donor and the recipient bed, and improve skin paddle survival with early pedicle division.     

真皮下血管网皮瓣蒂部的作用

考察真皮下血管网皮瓣的蒂部作用。方法用健康，白色家猪的实验，按自身相互对照原则在动物躯干两侧分别设计真皮下血管网皮瓣，传统皮瓣动物模型。通过两组皮瓣成过程的大体观察，及皮瓣ＥＣＴ检查核素分布情况的比较方法进行研究。     

大白鼠背部真皮下血管网皮瓣蒂部功能的研究

目的探讨真皮下血管网皮瓣蒂部对皮瓣成活的作用。方法以大白鼠背部真皮下血管网皮瓣为主要研究对象,相同部位的真皮下血管网皮片为对照,设计皮瓣长宽比例为４∶１。皮瓣及皮片采用肉眼观察及仪器两种观察手段。将实验动物分为条件不同的３组,以毛发生长为最重要的观察指标。结果对１１６只大白鼠进行的实验研究,表明各组皮瓣的近端１／４生长良好。结论真皮下血管网皮瓣蒂部供血能力为皮瓣面积的１／４（长宽比为１∶１）。     

大白鼠背部真皮下血管网皮瓣蒂部功能的研究

目的 探讨真皮下血管网皮瓣蒂部对皮瓣成活的作用。方法 以大白鼠背部真皮下血管网皮瓣为主要研究对象,相同部位的真皮下血管网皮片为对照,设计皮瓣长宽比例为4：1。皮瓣及皮片采用肉眼观察及仪器两种观察手段。将实验动物分为条件不同的3组,以毛发生长为最重要的观察指标。结果 对116只大白鼠进行的实验研究,表明各组皮瓣的近端1／4生长良好。结论 真皮下血管网皮瓣蒂部供血能力为皮瓣面积的1／4（长宽比为1：1）。     

大白鼠背部真皮下血管网皮瓣蒂部功能的研究

目的探讨真皮下血管网皮瓣蒂部对皮瓣成活的作用。方法以大白鼠背部真皮下血管网皮瓣为主要研究对象,相同部位的真皮下血管网皮片为对照,设计皮瓣长宽比例为4:1。皮瓣及皮片采用肉眼观察及仪器两种观察手段。将实验动物分为条件不同的3组,以毛发生长为最重要的观察指标。结果对116只大白鼠进行的实验研究,表明各组皮瓣的近端1/4生长良好。结论真皮下血管网皮瓣蒂部供血能力为皮瓣面积的1/4(长宽比为1:1)。     

Methods of vascular pedicle coverage

Based on our clinical experience, various methods of donor or recipient vascular pedicle coverage for an arterialized or free flap are reported. The vascular pedicle may be placed in the subcutaneous space either by incising the skin along the full length of the vascular route or by passing it through a subcutaneous tunnel. It has been our experience that the vascular pedicle can also be covered by either a local flap or a free skin graft. On rare occasions, a narrow skin flap strip including the vascular pedicle can be lifted en bloc and rotated toward the base of the area transferred.     

The effect of single administration of vascular endothelial growth factor or L-arginine on necrosis and vasculature of the epigastric flap in the rat model.

OBJECTIVES: Vascular endothelial growth factor (VEGF) and nitric oxide (NO) produce vasodilation, induce angiogenesis, and improve survival of surgical flaps. We used the rat epigastric skin flap to study the effect of a single intra-arterial dose of VEGF or L-arginine, a substrate for NO production, on flap regional necrosis and pedicle dependence of flap perfusion. METHODS: In 30 Sprague-Dawley rats an 8 x 8 cm2 skin flap, consisting of four vertical zones marked A through D (right to left), based on the proximal right inferior epigastric vessels was raised. Subsequently, 1 ml of either saline (control, n =10), 5 microg VEGF (VEGF, n = 10), or 50 mg of L-arginine (L-arginine, n = 10) was injected into the arterial pedicle by cannulating the right saphenous artery, and the flap was resutured in place. After 8 days, the animals were perfused systemically with 15 microm coloured fluorescent microspheres before (blue) and after (yellow-green) ligation of the right inferior epigastric vascular pedicle. After sacrifice, the area of flap necrosis was measured in each zone by templates and weight-to-surface ratio, and the flap zones were harvested and processed for determination of fluorescence and blood flow. RESULTS: Administration of VEGF or L-arginine resulted in decreased total and regional (zone D) flap necrosis (ANOVA <0.001). The total and regional flap shrinkage was greater in the experimental groups (ANOVA <0.02). While VEGF and L-arginine decreased the percentage of necrosis in the zone most distal to the pedicle (ANOVA <0.01) only L-arginine diminished percentage of total flap necrosis (p = 0.04). In the VEGF group, total and regional flap perfusion did not change after pedicle ligation, but perfusion decreased significantly in zones B through D in the L-arginine treated rats. CONCLUSION: Single intra-pedicle administration of VEGF or L-arginine decreased necrosis of the epigastric skin flap at 8 days postoperatively, but flap shrinkage also increased in the zone with the greatest degree of necrosis. Perfusion data suggest that beneficial effects of VEGF and L-arginine on flap survival may be based on different mechanisms.     

Experimental study on the reconstruction of vascular links between a pedicle skin flap with preserved subcutaneous vascular network and its implanting bed]

A comparative study of skin flap with a preserved subcutaneous vascular network and conventional skin flap was undertaken in rats with determination of skin temperature, laser Doppler, ink perfusion, microangiography and transparent specimen technics. It was found that all the skin flaps with a preserved subcutaneous vascular network survived after transplantation. Three hours postoperation, the flap microcirculation was poorest (LDF, 28% of the preoperative value). Six hours postoperation, it began to augment, and microvessels containing ink could be seen under microscope at 24 hours, as compared to 3 days postoperation in the controls. On the fifth day, LDF returned to the preoperative level, and the diameter and density of reformed microvessels were similar to the vessels of the adjacent skin. This phenomenon only occurred on the 7th day in the controls. After division of the pedicle on the fifth day, all the flaps survived, while the controls showed partial necrosis. The results indicate that skin flaps with a preserved subcutaneous vascular network can survive on the blood flow of pedicle in the early stage, at 24 hours postoperation flap microvessels begin to reform, and on the fifth day flaps can survive on the reformed microcirculation in spite of the severance of the pedicle.     

pcD2/hVEGF对缺血皮瓣存活的影响

目的 观察并探讨pcD2/hVEGF对缺血皮瓣血循环重建和皮瓣存活率的影响.方法 SD大鼠24只,分2组,每组12只.在鼠背部制作蒂位于尾侧的缺血皮瓣(7cm×1cm).实验组皮下注射pcD2/hVEGF,对照组皮下注射生理盐水,术后7天观察皮瓣存活面积比、单位面积微血管计数和及VEGF基因表达水平.结果 2组中pcD2VEGF组皮瓣存活面积比、单位面积微血管密度与对照组有显著性差异.结论 pcD2VEGF能促进缺血皮瓣存活.