手部随意修复皮瓣甲襞微循环的观察*

背景：随意皮瓣循环的观察多通过激光多普勒血液灌流仪来完成,但未曾有过对随意皮瓣甲襞微循环进行过观察研究,而甲襞微循环是一种最为常见的外周循环检测方法。目的：通过对随意皮瓣的手指甲襞微循环进行观察,来了解皮瓣末梢微循环的变化情况。方法：选择河北医科大学第一医院烧伤整形外科收治的手部有皮肤组织缺损的患者进行随意皮瓣修复而并未进行特殊药物治疗的患者共有23例按照皮瓣移植后受伤肢体及健康肢体指端的甲襞微循环分为皮瓣组和对照组,观察皮瓣移植后即刻、7,15 d共3个时相的微循环形态、流态及襻周。结果与结论：皮瓣组移植后即刻微循环在清晰度、血流速度、红细胞聚集、渗出方面均有很大的变化,发生微循环障碍。移植后7 d,两组红细胞聚集比较差异无显著性意义(P > 0.05),而清晰度、血流速度及渗出比较差异有显著性意义(P < 0.05);移植后15 d,两组在清晰度、血流速度、红细胞聚集及渗出方面差异无显著性意义(P > 0.05)。提示,在临床治疗过程中,通过对指端微循环的观测,能够了解皮瓣血运建立情况,给临床皮瓣断蒂提供依据。

Observation of nail fold microcirculation repaired with a random flap

BACKGROUND: Laser Doppler blood perfusion instrument is mostly used to observe random skin flap circulation, but there had been no study addressing a random flap nail fold microcirculation observation, which is a common method for detecting peripheral circulation.OBJECTIVE: The nail fold microcirculation on random flap was observed to understand the flap changes in peripheral microcirculation.METHODS: Totally 23 cases with hand skin defects were treated by free flaps and did not special drug treatment in the Burns and Plastic Surgery, the First Hospital of Hebei Medical University, were selected and divided into the flap and control groups according to nail fold microcirculation after surgery. The morphology, flow pattern and perivascular tissue of microcirculation at immediately, 7 and 15 days after flap transplantation were observed. RESULTS AND CONCLUSION: Microcirculation immediately after flap transplantation verified in definition, blood flow velocity, erythrocyte aggregation, and leakage, which showed the occurrence of microcirculation disturbance. There were no significant differences between the two groups in erythrocyte aggregation at 7 days after transplantation (P > 0.05); while difference was significant in the definition, blood flow velocity and leakage (P < 0.05). At 15 days after transplantation, there were no significant differences in the definition, blood flow velocity, erythrocyte aggregation and leakage between the two groups (P > 0.05). The findings suggest that, observation of microcirculation of nail fold can display the flap blood supply and provide basis for flap pedicle division in the clinical course of treatment.