静脉超引流与动脉增压对皮瓣存活的影响

目的比较静脉超引流与动脉增压对穿支皮瓣微循环血流动力学的影响,为降低皮瓣的坏死率,提高其存活面积提供一定的依据。方法雄性SD大鼠60只,体重450~550g,分成实验组A、实验组B及对照组,每组20只。实验组A,分离并结扎肋间后动脉保留伴行静脉;实验组B,分离并结扎肋间后静脉保留伴行动脉;对照组,肋间后动、静脉均结扎切断。在术后6h、1d、2d、3d、7d,超声多普勒测量两个"choke区"的经皮血流量和氧分压,7d后测量皮瓣存活面积和进行明胶氧化铅血管造影。结果术后7d,实验组A皮瓣几乎全部存活(98.2±1.6)%,实验组B皮瓣存活面积(74.78±5.91)%,对照组存活面积(60.3±7.8)%(两两比较P0.01)。从术后6h到7d,实验组A相比于实验组B和对照组血流量和氧分压是最高的(均P0.05)。实验组A,肋间后静脉和髂腰穿支吻合区"choke vessel 1"区血管吻合丰富,而且肋间后穿支和胸背穿支吻合区"choke vessel 2"区比实验组B和对照组吻合都要明显;实验组B出现了动静脉的吻合,对照组皮瓣远端严重坏死,"choke vessel 2"区血管吻合不明显。结论静脉超引流比动脉增压效果更明显,更能有效地改善微循环血流灌注效果,提高皮瓣的存活率。

Comparison between venous superdrainage and arterial supercharging on flap survival

Objective To compare the effects of venous superdrainage and artery supercharging to perforator flap hemodynamics, therefore, reducing the rate of flap necrosis, improving their survival area, and providing some basis for flap survival. Methods Sixty Sprague-Dawley rats, weighing （500±50）g, were divided into three groups: experimental group A (Exp A), experimental group B (Exp B), and control group (control)), 20 rats each group. In the experimental group A, the posterior intercostal artery was ligated while the accompanying vein was reserved. In the experimental group B, the posterior intercostal vein was ligated while accompanying artery was reserved. In the control group, the posterior intercostal artery and vein were ligated. Laser Doppler imaging was used to evaluate flap perfusion in the two “choke area”, 6 h, 1day, 2days, 3days and 7days after surgery. On postoperative day (POD) 7, survival areas of flaps were calculated and lead oxide-gelatine was used for vascular angiography. Results In Exp A, all flaps survived (98.2±1.6)%; in Exp B, flap survival area was (74.78±5.91)%; in Control, survival area was (60.3±7.8%)(P<0.001). From 6 hours to 7days postoperatively, blood flow or oxygen partial pressure of flaps in Exp A was significantly higher than Exp B and Control（P<0.05）. On angiography, anastomosisof the choke vessels in Exp A was richer than in Exp. B and Control. In Control, flap necrosis due to poor blood circulation, vascular anastomosis and distal venosome were not seen. Conclusion The effect of venous superdrainage was more apparent than arterial supercharging, and may effectively alter hemodynamics of microcirculation, and improve survival area of skin flap.