动脉化静脉皮瓣坏死原因的探讨及皮瓣改造  

The causes of necrosis of arteriovenous flap and its modification

作　　者：刘春利[1] 鲁开化[2] 吴宛堃 林海[3] 

机构地区：[1]广州第一军医大学南方医院整形科,510515 [2]西安第四军医大学西京医院整形外科中心 [3]西安第四军医大学四○三所

出　　处：《中华整形烧伤外科杂志》1994年第3期173-177,共5页

摘　　要：应用微循环显微镜活体观察动脉化静脉皮瓣,发现术后早期皮瓣微血管绝大部分处于关闭状态,原因与静脉短路循环,高压高氧动脉血损伤微血管内皮细胞以及微血栓形成等有关。72小时后微血管灌流明显改善,根据皮肤扩张器能增加组织血管密度,以及静脉内皮细胞对动脉血流需逐渐适应的特点,对皮瓣进行改造后,其成活率明显提高。Arteriovenous flaps have been developed for more than ten years,however the cause of necrosis of the flap remains obscure.We observed the changes in the microcircu- lation of the flap,and it was revealed that most of capillaries were occluded in the early arte- rialized stage,and the capillary patency was only 10%～20%.The latter was increased to 80%～90% three days later.All these changes were due to the damage of endothelial cells by arterial blood,because of high pressure and oxygen tension,resulting if cell swelling,fis- suring,exfoliation and finally thrombosis.As a consequenec,the effective microcirculation volume became decreased.As venous endothelial cells required time to adapt arterial blood, and expansion of skin could increase tissue capillaries in number,the arteriovenous flap was modified by skin expansion before arterialization.This method improved the survival rate re- markably.

关 键 词：静脉动脉化 皮瓣 微循环 

分 类 号：R622.1[医药卫生—整形外科]