真皮下血管网皮瓣血流量与皮瓣成活关系

目的：通过对兔背部真皮下血管网皮瓣断蒂时及断蒂后10d血流量的监测，分析血流量变化与皮瓣成活的关系。探求皮瓣断蒂指征。提出皮瓣成活的客观标准，为临床治疗提供依据。方法：以兔为实验动物，行背部真皮下血管网皮瓣成形术。术后7d断蒂。断蒂前使用激光多普勒血流仪（Laser Doppler flowmetry，LDF）测定皮瓣阻断实验前后皮瓣血流灌注量（Perfuseunit，PU）。并对皮瓣断蒂后10d的PU进行连续监测并与周围正常皮区PU值进行比较。10d后处死动物取皮瓣组织行病理检查。按坏死与否将皮瓣分为两组：成活组与坏死组。分析两组皮瓣血流量变化情况并得出结论。结果：成活组断蒂时阻断试验前后PU比值（阻断比值）明显高于坏死组，且成活组PU值在断蒂后1～10d均显著高于坏死组（P〈0.01）；成活组与坏死组断蒂后10d周边皮区的PU值无统计学差异（P〉0.05）；成活组断蒂后10d皮瓣与周围正常皮区PU比值（瓣周比值）为70．1±11．2。结论：真皮下血管网皮瓣断蒂后皮瓣血流灌注量随皮瓣断蒂时阻断实验前后PU比值增高而增高；皮瓣的最佳断蒂时机为：①皮瓣成形术后7d以上。②肉眼观察皮瓣存活。③LDF测量阻断比值大于44．6％。皮瓣成活的标准为：断蒂术后10d肉眼观察成活且皮瓣与周围正常皮区灌注量比值大于58．9％。

Monitoring and Analyzing on Perfusing Unit in Skin-flaps with Subdermal Vascular Plexus

Objective：To investigate objective criterion for living skin-flap,decide when the best opportunity is to break the pedicle of skin-flap and provide evidences for clinical treatment. Perfuse unit （PU） of skin-flaps with subdermal vascular plexus was monitored ten days after and before break-pedicle operation in rabbits. The relation between PU and alive skin-flap was analyzed. Methods： Skin-flaps＇ PU with subdermal vascular plexus was measured by Laser Doppler flowmetry（LDF）before and after the intercept-test. PU of skin around skin flap was measured as well. Skin -flaps were divided into two groups according to existing by patho- exam ten days after break-pedicle operation： Living group and necrosis group. PU＇s Variance of two groups was analyzed. Results：PU Ratio before and after the intercept-test（Intercept-Ratio）and PU in living group is higher than that of necrosis group obviously（Ratio of PU in living group is 66.0±21.4%） （P〈0. 01）. There is no statistical difference between PU of skin-flap and skin around the skin flaps. （P〉0.05）. Ratio of PU skin flap and skin around skin flap（Circumference-Ratio）was 70.1 ± 11.2 in living group alive. Conclusion：The PU increase of skin flaps with subdermal vascular plexus after break-pedicle operation followed intercept-Ratio; The best opportunity of break-pedicle operation was constituted by three main points ：（1）It should be done above seven days after plasty of skin-flap. （2）Survivorship should be confirmed by macroscopic observation. （3）Intercept-Ratio of skin flap should exceeded 44.6%. The standard of living skin flap is that Circumference-Ratio ex-eeeded 58.9% on the tcnth day after break-pedicle operation and survivorship of skin-flap should be confirmed by eyes.