浅静脉干及其滋养血管放射自显影动物实验研究

目的：探讨浅静脉干滋养血管在皮瓣存活中的作用。方法：在6头白色家猪的腹部设计以腹壁浅静脉为轴,蒂在近心端的局部皮瓣,按静脉干的处理不同分成实验组（皮瓣内包含浅静脉及其周围组织）和对照组（将浅静脉干及其周围0．5cm内的软组织在蒂部结扎后切断）。用^99mTc标记红细胞,然后ECT检测分析。结果：术后2h实验组与对照组皮瓣蒂部出现少许散在性放射核素影像;术后4h实验组皮瓣中远端出现放射性核素影像,而对照组仅蒂部影像增多;术后6h实验组皮瓣绝大部分区域出现放射性核素显像,对照组皮瓣远端始终末记录到放射性核素影像。结论：浅静脉干及其滋养血管对皮瓣的成活有重要作用。     

浅静脉干及其滋养血管对静脉皮瓣成活的影响

静脉在皮瓣成活中的作用越来越受到人们的重视 ,单纯静脉蒂皮瓣临床应用获得成功 ,但其成活机制仍不甚清楚。既往研究只注重静脉内血流的作用 ,而对静脉干本身的研究较少 ,浅静脉是否存在滋养血管 ?如果有 ,其对静脉皮瓣的成活作用和意义如何 ?为此 ,我们进行了实验研究 ,现报道如下。材料与方法一、标本与仪器正常成人新鲜上肢标本 3具 ,2 0 %泛影葡胺 2 0 ml× 10支 ,义齿基托枝脂 ,自凝牙托水 ,手术显微镜 ,Olympus照相机 ,冲洗相材设备。二、实验方法1.血管造影 :2 0 %泛影葡胺 2 0 ml加入等量生理盐水稀释 ,X线监视下 ,首先用稀释后的…     

浅静脉干在皮瓣成活中的作用实验研究

目的 :探讨浅静脉干在局部皮瓣成活中的作用。　方法 :在猪的大腿及腹部设计蒂在近端的长宽比为 4:1的局部皮瓣 (2 0× 5 cm) ,按静脉干的处理不同分三组 : 组包含浅静脉干及其周围组织 , 组将浅静脉干在皮瓣蒂部栓塞 , 组将浅静脉干及其周围 0 .5 cm内的软组织结扎切断。术后即刻 ,2 4h,48h用激光多普勒血流探测仪检测皮瓣蒂部 ,中部 ,远端的微循环血流情况 ,7天观察各组皮瓣成活情况 ,术后 7天切取 、 组皮瓣 ,自蒂部用 10 %硫酸钡钡餐乳剂行静脉干逆行造影。　结果 : 、 组间蒂部不同时期微循环血流灌注速率 ,峰值均数比较无显著差别 (P>0 .0 5 )。　结论 :局部皮瓣带上浅静脉干不仅可以通过其本身的滋养系统为皮瓣提供部分血供 ,同时其与周围组织的广泛联系亦有助于皮瓣的引流 ,尤其是浅静脉干的引流作用更重要 ,实验中未发现有静脉血倒灌现象存在     

动脉化静脉皮瓣的实验研究

目的：利用兔耳动脉化静脉皮瓣模型，观察皮瓣的成活过程，探讨其成活机制。方法：实验采用３０只兔５６侧耳随机分为４组。观察方法包括肉眼观察、荧光素试验、Ｘ线造影、透明标本、血气分析、组织学检查及扫描电镜。结果：实验组成活２２／２６，对照１组成活５／１０，对照２组成活４／１０，对照３组成活１０／１０。实验组与对照１、２组结果的差异有显著性意义（Ｐ＜０．０５，Ｐ＜０．０５），而与对照３组结果的差异无显著性意义（Ｐ＞０．１）结论：实验结果肯定了兔耳动脉化静脉皮瓣能够成活。并证明动脉化静脉灌注的有效性。     

带浅静脉干逆行皮瓣早期微血管构筑变化的体视学研究

目的 探讨带浅静脉干的逆行皮瓣早期微血管构筑变化的特点以供临床实践参考。方法 应用生物体视学技术测量带浅静脉干皮瓣微血管体积密度，结合组织学观察，与不带静脉干皮瓣作对照比较。结果 带浅静脉干皮瓣组微血管密度整体水平高于不带静脉干皮瓣组（P〈0．05）。结论 浅静脉干的存在有利于皮瓣的血管化进程，保留浅静脉干对皮瓣成活有利。     

家兔逆行隐动脉皮瓣中静脉干对静脉回流影响的实验研究

目的通过活体动物实验模型，研究家兔逆行岛状皮瓣中静脉干对皮瓣静脉回流的影响。方法利用家兔隐动静脉模型做成逆行岛状皮瓣的实验模型，实验分为3组：A组静脉干组（皮瓣蒂远端结扎静脉干）；B组无静脉干组（皮瓣近端、远端结扎静脉干）；C组静脉干＋表面渗出组（皮瓣远端结扎静脉），在皮瓣表面作切口引流。观察初始、术后各个时间段静脉干对皮瓣静脉回流的影响。观察指标：皮瓣大体观察；静脉压力测定；血管口径、血流情况观察；组织学检查。结果静脉压测定：A，B，C组皮瓣术后静脉压力均较术前升高（P〈0.05）；A，B组皮瓣的静脉压在术后各时间点的差异有统计学意义（P〈0.05），C组与A组无明显差异。微循环观测：三组皮瓣蒂部静脉干的血管口径在术后均有不同程度扩张，B组管径扩张程度较A，C组明显，A，C组血管管径至术后7d时接近术前水平；但B组仍高于初始水平。A，C组皮瓣蒂部静脉干开始血流方向由皮瓣蒂部向皮瓣远端流动，而后血流速度减慢；自术后2h，皮瓣内血液开始直接通过静脉干向皮瓣蒂部逆流。B组皮瓣蒂部静脉干未见静脉中有血液流动。术后12d观察，B组皮瓣中可见新生小血管，皮瓣成活率最低。结论静脉干对逆行岛状皮瓣的静脉回流起促进作用；静脉瓣膜失效机制在逆行岛状皮瓣静脉回流过程中起主要作用；单纯依靠迷宫式回流不能保证皮瓣静脉充分回流；增加皮瓣表面渗出在皮瓣静脉回流中未见明显作用。     

应用颞浅血管蒂耳后复合组织皮瓣修复下睑外翻畸形

目的报道应用颞浅血管蒂耳后复合组织皮瓣修复下睑外翻畸形的临床效果。方法以血管吻合支的不同将颞浅血管为蒂的耳后皮瓣分为长、短蒂，同时携带耳甲软骨重建下睑支撑系统，防止皮瓣松弛下垂。结果临床应用6例，术后睑下外翻畸形得到完全矫正，皮瓣全部成活。结论不同血管吻合支的颞浅血管蒂耳后复合组织皮瓣是修复下睑外翻的良好方法。     

动脉化静脉皮瓣移植的实验研究及临床应用

为了探讨动脉化静脉皮瓣成活机理及静脉回流对皮瓣成活的影响，选用健康家兔３４只，随机分为实验组和三个对照组：①实验组，切断中央动脉、静脉及神经，将中央动脉近心端与中央静脉远心端吻合，保留前、后边缘静脉；②对照１组，保留中央静脉及前、后边缘静脉，结扎并切断中央动脉；③对照２组，结扎后边缘静脉，其余同实验组；④对照组３组，切断中央动脉、静脉，重新吻合中央动脉，保留前、后边缘静脉。以兔耳动脉化静脉皮瓣为模     

带腓肠神经伴行血管蒂岛状皮瓣的解剖学研究

目的探讨带腓肠神经伴行血管蒂岛状皮瓣的最大切取面积，并比较皮神经蒂皮瓣与静脉皮瓣、筋膜皮瓣、传统带蒂皮瓣在成活面积之间的差异性。方法取４侧新鲜成人尸体小腿，从小隐静脉逆行灌注美蓝并观察其蓝染面积的范围。另采用ＳＤ大鼠４０只，随机分成４组，每组１０只。建立大鼠股部皮神经蒂皮瓣及上述３种皮瓣的模型，术后６天测量各组皮瓣成活面积。结果小腿后外侧皮肤出现蓝染面积在１２ｃｍ×１７ｃｍ范围内。大鼠皮瓣成活面积以传统带蒂皮瓣、皮神经蒂皮瓣为佳，两者差异无显著性意义（Ｐ＞０．０５）。筋膜皮瓣次之，静脉皮瓣最差。结论带腓肠神经伴行血管蒂岛状皮瓣的最大切取面积不宜超过１２ｃｍ×１７ｃｍ。术时保留皮瓣内浅静脉和蒂部的部分深筋膜可提高皮神经皮瓣的成活率。     

以皮神经营养血管为蒂岛状皮瓣的基础研究

目的　阐述以皮神经营养血管为蒂岛状皮瓣的成活机制 ,以及它与筋膜蒂、静脉蒂岛状皮瓣三者的关系。方法　以新西兰大白兔为动物模型 ,根据以筋膜、静脉、皮神经三者相互组合为蒂 ,设计出 7组不同类型的皮瓣 ,每组 3只。应用放射性核素99mTcO-4 和99mTc -MAA来测定皮瓣的动脉供血和毛细血管静脉回流情况 ,以及与皮瓣成活的关系。结果　单纯以筋膜、静脉、皮神经为蒂的岛状皮瓣全部坏死。D组皮瓣 (蒂部组织为小隐静脉和筋膜组织 )成活率为 [(6 8.5 1± 5 .41) % , x±s ,下同 ] ,E组皮瓣(蒂部组织为小隐静脉和腓肠神经 )成活率为 (94.2 4± 3 .2 2 ) %。F组皮瓣 (蒂部组织为筋膜组织 ,含腓肠神经无小隐静脉 )成活率为 (73 .41± 6 .12 ) %。G组皮瓣 (蒂部组织为筋膜组织 ,含腓肠神经和小隐静脉 )成活率为 (98.5 4± 1.12 ) %。放射性核素99mTcO-4 检测结果 :皮神经营养血管蒂较单纯的筋膜蒂、静脉蒂有充分的动脉供血。包含浅静脉的皮瓣中 ,皮神经营养血管蒂皮瓣的99mTco-4 清除率最快。结论　神经旁组织因含有与神经伴行的营养血管 ,其分支与皮下血管网相吻合对皮瓣提供动脉供血 ;浅静脉对皮瓣提供血液回流 ,使皮瓣血液循环更为通畅。神经旁带少量 (0 .2cm)筋膜组织 ,可保证手术时蒂部神经营养血管不被破     

兔耳逆行皮瓣中浅静脉干的压强测定

目的：明确静脉血是否会顺着浅静脉干倒灌入逆行皮瓣内,从而为探索浅静脉干在逆行皮瓣中的作用提供依据。方法：采用墨汁灌注以明确静脉是否会顺着浅静脉干倒灌入逆行皮瓣内,并用病理切片以明确。浅静脉干内压强的测定,进一步说明是否倒灌的原因。结果：墨汁未顺浅静脉干倒灌入逆行皮瓣内,逆行皮瓣内的静脉压显著高于蒂部的静脉压。结论：静脉血不会顺着浅静脉干倒灌入逆行皮瓣内,不会增加逆行皮瓣的静脉回流负担。但浅静脉干是否能促进逆行皮瓣的静脉回流尚需进一步研究。     

Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm

The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.     

Axial pattern skin flaps in cats

The major direct cutaneous vessels identified in the cat include the omocervical, thoracodorsal, deep circumflex iliac, and caudal superficial epigastric arteries. Axial pattern skin flaps based on the thoracodorsal and caudal superficial epigastric arteries have been developed in cats. Rotation of these flaps as islands allows skin coverage to the carpus and metatarsus, respectively. The thoracodorsal and caudal superficial epigastric flaps provide a practical, one-step option in the reconstruction of large skin defects involving the distal extremities of cats.     

Comparison of normal and venous flaps. An experimental study]

The abdominal skin of 135 rats was fashioned to be normal on venous flap for investigating the difference in quality of the two. For normal flap, the right superficial epigastric artery was used to serve as the nourishing vessel and the left superficial epigastric vein the draining one. For venous flap, the right superficial epigastric vein was made to be the nourishing vessel and the left superficial epigastric vein the draining one. The flap in group I was fed with blood from the distal end of the femoral vein; the flap in group II was supplied with blood from the distal end of the femoral artery; and the flap in group III was nourished with blood from the femoral artery. It demonstrated that the venous flaps in group I were better in quality than the normal flaps in terms of survival rate, elasticity and size of ulcer. However, the results in group II and group III were quite different. As for clinical use, it would be all right to cover small wound with venous flap; while repairing large defect, particularly in exposed part or area near a joint, normal flap should be of the choice.     

Anatomy and circulation of the canine skin

The skin of the dog has several anatomic differences from human skin. Skin thickness, hair growth, and circulation vary regionally in the dog and between breeds to some degree. Direct cutaneous arteries supply the canine skin. The deep or subdermal layer is closely associated with the panniculus muscle (where present) and should be elevated with the overlying skin during routine flap elevation or undermining procedures. Flaps in the dog elevated without inclusion of a direct cutaneous artery and vein have been termed subdermal plexus flaps to avoid confusing them with random flaps in the human based on musculocutaneous vessels. Axial pattern flaps developed for veterinary clinical use are discussed, several of which have potential for free flap transfer in cutaneous reconstructive surgery.     

逆行皮瓣中浅静脉干的形态学与血流动力学观察

目的：通过对浅静脉干的形态学和血流动力学观察，探索浅静脉干促进逆行皮瓣静脉回流的机理，进一步指导带浅静脉千逆行皮瓣的临床应用。方法：用小鼠耳制成带浅静脉干的逆行皮瓣模型共48例，每个皮瓣内只有一条浅静脉干，用微循环观察仪对浅静脉干进行形态学和血流动力学观察。结果：根据形态可将逆行皮瓣中的浅静脉千分为3种类型：“I”形，“Y”形和树枝形，各种类型的浅静脉干都是皮瓣静脉逆向回流的主要通道，如果在蒂部将浅静脉干闭塞，皮瓣的静脉回流基本停滞。结论：浅静脉千的存在有助于逆行皮瓣的静脉逆向回流，并在回流中起类似“枢纽”的重要作用，临床应尽量选用“I”形浅静脉干。     

皮瓣受区床与缺血-再灌注皮瓣成活的关系

目的 :探讨皮瓣受区床对缺血 -再灌注皮瓣成活的影响 ,重视受区床的营养性作用。　方法 :40只大鼠分成 A组 (皮瓣下不置硅胶膜 )、 B组 (皮瓣下置硅胶膜后再缝合 )。阻断腹壁浅血管 1h、 6 h、 10 h及完全切断腹壁浅血管 ,观测不同时段皮瓣温度及组织病理改变 ,7天时计算皮瓣成活面积。　结果 :皮瓣温度、皮瓣成活面积及组织病理学改变阻断血管1h A、 B组无明显差别 ,阻断 6 h、 10 h及完全切断血管两组间有显著差别。 A组阻断 10 h与完全切断血管两组间皮瓣成活面积很相近。 A组完全切断血管后真皮下组织见白细胞大量聚积。　结论 :皮瓣受区床对缺血 -再灌注皮瓣成活起营养作用。白细胞可损害这种营养性作用。     

Reconstruction of large defects in the scalp with fasciocutaneous flaps.

Although recent reports have emphasised free microsurgical transfer for reconstruction of extensive defects in the scalp, in our experience a carefully planned scalp flap is a simpler and safer method than a free transfer. Twenty-one patients with defects as large as 10%-60% of the scalp surface area were reconstructed; the calvarium was resected in five cases and the dura mater in two. In 18 cases the flaps were based on a single pedicle: the superficial temporal artery. In three cases the blood supply of the flaps was based on three major homolateral arteries: the superficial temporal, the posterior auricular, and the occipital. The blood supply of all scalp flaps was based on the interconnected network of the aponeurotic plexus and the pedicles were included into flap in 18 cases. The principles of fasciocutaneous flaps were applied for all 21 scalp flaps. The reconstruction of the skull was delayed in all cases, and the dura was replaced by free autogenous periosteum. The donor area was covered with a skin graft in all cases. In all patients the aesthetic and functional results were considered excellent by them and by us. There were no postoperative complications.