超量扩张皮肤血流量改变的初步临床观察

目的 探讨超量扩张时皮肤血流量的变化与皮瓣存活的关系。方法 对临床10例患者21个扩张器在扩张器置入前、满量、超量注水时，应用激光多谱勒血流测定仪测定扩张皮肤微循环血流量及其波幅，并与最终临床效果进行观察比较。结果 正常皮肤血流量及血管的运动波较小且较稳定，扩张后尤其是超量扩张后其血流量明显增加。与正常皮肤相比差异有统计学意义（P〈0．05），血管的运动波与正常皮肤相比差异亦有统计学意义（P（0．05），与超量注水扩张皮肤相比差异有显著的统计学意义（P（0．01）。结论 扩张皮肤血流量的增加，主要表现为血管数量的增加和增粗，当扩张皮瓣的长宽比例较大时，尤其在过度扩张时，扩张皮肤的血供不像延迟皮瓣具有方向性，加上微血管括约肌的功能异常，更易出现皮瓣远端血供的不足，并为皮瓣转移时带来风险。

Clinical observation of blood flow changes in exceedingly expanded skin

Objective To investigate the relationship between the change of blood flow in exceedingly expanded skin and the viability of the flaps. Methods In 21 expansions of 10 patients, the skin blood flow and its amplitude were measured by laser Doppler in different stages. The results were compared with the final outcomes of patients. Results The volume of blood flow and its amplitude of normal skin were very low and stable, but after expanded, the volume of blood flow and the amplitude grew up, which were significantly higher than that of normal skin (P<0.05), especially blood amplitude (P<0.01). Conclusions The increase of the skin blood flow in the expanded skin is owing to the increase of vessel number and its diameter. Especially in exceedingly expansion, the blood providing the expanded skin flap is not the same as that in delay skin flap that has the direction of blood flow. Together with the dysfunction of sphincter, blood transportation in the expanded skin flap appears to be easily disturbed when the proportion of length and broad in the expanded skin flap is exceedingly increased.