改良双干静脉动脉化皮瓣的实验研究

目的　观察双干静脉动脉化皮瓣与改良双干动脉化静脉皮瓣存活过程，对比成活率及探讨其成活机制。 方法　将 20只新西兰大白兔40侧后肢制成包含2根纵行的浅静脉2.5cm×3.5cm皮瓣，将其随机分成对照组和实验组各20侧。对照组：将皮瓣直接移植同侧耳背2.0cm×3.0cm创面，制作双干动脉化静脉皮瓣模型。实验组：在对照组基础上将皮瓣进行改良。观察皮瓣的成活过程，并进行比较。 结果　实验组皮瓣存活70%（14个），部分存活20% （4个），坏死10%（2个）。对照组皮瓣存活20%（4个），部分存活25%（5个），坏死55%（11个）。两组差异有统计学意义(P＜0.05)。 结论　双干静脉动脉化皮瓣经改良后有利于皮瓣内血液进入微循环，改善动脉血灌注量与静脉回流量平衡，提高皮瓣的成活率。

Experimental study of the modified double stem arterialized venous skin flap

Objective To explore survival rate and survival mechanism of the modified double stem arterialized venous skin flaps.Methods 40 venous skin flaps of hind limbs with two vein trunks and size of 2.0cm×3.0cm were obtained from New Zealand white rabbits.The flaps were randomly divided into two groups: the control group and the study group.For heterotopic replanted arterialized venous skin flap in the control group,central artery and central vein at the back of rabbits’ear were anastomosed.For study groups,"opening groove" were performed(fat tissues of flap were cut to reach subdermal vascular plexus and keep its integrity by ligating all communicating branches).Survival of all skin flaps was recorded.Results In study group,14 skin flaps survived,while 4 skin flaps had partial necrosis and 2 complete necrosis.In the control group,4 skin flaps survived,5 skin flaps had partial necrosis and 11 complete necrosis.There was significant difference in the survival rate between two groups(P<0.05).Conclusions Modification of arterialized venous skin flap is useful to bleed into micro-circulation and reach the balance of arterial supply and venous drainage.It may improve the survival rate of arterialized venous skin flap.