主干蒂与穿支蒂穿支皮瓣血流动力学的比较研究

目的研究主干蒂与穿支蒂穿支皮瓣血流动力学的差异。方法选成年小型猪4只,雌雄各2只,体重23.0±2.0kg。设计自身对照的以两侧腹壁上动脉主干血管或其穿支为蒂的腹部横行皮瓣,一组为逆行解剖血管蒂至腹壁上动脉主干的穿支皮瓣;一组为腹壁上血管腹直肌穿支为蒂的穿支皮瓣。于术后2h,1、2和3周分别以激光多普勒血流仪测量皮瓣皮肤的血流灌注量,以彩色多普勒超声测定腹壁上动脉的血流速度。术后1周计算皮瓣成活面积。3周时处死动物行氧化铅凝胶动脉灌注皮瓣造影。结果术后2h、1周时主干蒂穿支皮瓣较穿支蒂穿支皮瓣水肿严重;两组皮瓣的皮肤血流灌注量有统计学差异（P〈0.05）,术后2、3周两组皮瓣皮肤的血液灌注量、皮瓣的坏死面积（主干蒂穿支皮瓣组19.73%±3.21%;穿支蒂穿支皮瓣组19.81%±3.33%）无统计学差异（P〉0.05）。术后2h、1周时主干蒂穿支皮瓣组的腹壁上动脉平均流速减慢,与另一组比较有统计学差异（P〈0.05）;术后2、3周时两组接近。3周时皮瓣造影显示主干蒂穿支皮瓣组的腹壁上血管有新生血管。结论1主干为血管蒂的穿支皮瓣血流动力学表现在术后1周皮瓣皮肤血流灌注量下降,但不影响皮瓣的成活面积;2血管主干至其他组织的或受区血管的分支结扎不能对皮瓣起到超灌注的作用。

INFLUENCE OF PEDICLE LENGTH ON PERFORATOR FLAP IN HEMODYNAMICS

OBJECTIVE: To study the influence of the pedicle length on the perforator flaps in hemodynamics. METHODS: Four mature swine (2 males, 2 females; weight, 23.0 +/- 2.0 kg) were applied to the experiment. Two transverse abdominal skin flaps, based on the superior epigastric pedicle or its rectus abdominal muscle perforators, were designed; each swine was used as its own control. At 2 hours and 1, 2, 3 weeks postoperatively, the skin paddle perfusion and the blood stream velocity in the superior epigastric artery were measured by the Laser Doppler Flowmeter and the Color Doppler Ultrasound, respectively. Flap survival percentages were calculated by the grid method at 1 week postoperatively. The swine were euthanatized, and they underwent angiography at 3 weeks postoperatively. RESULTS: At 2 hours and 1 week after operation, edema of the perforator flaps with the superior epigastric pedicle was more severe than that of the skin flaps with the rectus abdominal muscle perforator, and the skin perfusion had a statistical difference between the two kinds of flaps (P<0.05). The skin paddle viability and the skin perfusion had no statistical difference after the first week postoperatively (P>0.05). At 2 hours and 1 week after operation, the blood stream velocity in the superior epigastric artery in the perforator flap with the superior abdominal artery pedicle was reduced, and there was a statistical difference between the two kinds of flaps (P<0.05); however, the velocity was almost the same after the first week postoperatively. CONCLUSION: The excessively long pedicle of the perforator skin flap may have an unfavorable influence on the flap perfusion, especially during the first week after operation, because of the vascular compromise during the dissection of the long pedicle. The blood vessel anastomosis at this level of the blood vessels may have no relationship with the perforator flap in hemodynamics. This study can also indicate that the ligation of the branches in the recipient vessels cannot make the perforator flaps overperfused.