跨区供血皮瓣成活过程中血管构筑及内源性VEGF变化的实验研究  

Experiment of the alteration of vascular and endogenous vascular endothelial growth factor in the survival process of the reverse-flow axial skin flap

作　　者：韩雪峰[1] 李健宁[2] 杨大平[1] 聂春磊[1] 刘国锋[1] 郭铁芳[1] 郝晨光[1] 马辉 谷守滨[1] 

机构地区：[1]哈尔滨医科大学附属第二医院整形外科 [2]北京大学第三医院成形科 [3]黑龙江省省人民医院骨科

出　　处：《中国美容医学》2008年第2期232-234,共3页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探索跨区供血皮瓣的成活机制。方法:以大鼠旋髂深动脉为蒂制作包含肋间后动脉支配区域的右侧背部矩形跨区供血皮瓣,分别于术后即刻,术后1,2,3,5,7天时,观察皮瓣成活情况,成活过程中血管构筑及蒂部血管口径的改变以及内源性血管内皮细胞生长因子(Endogenous Vascular Endothelial Growth Factor,VEGF)免疫组化染色(取材部位为两血管支配区域中间血管网吻合部)。结果:皮瓣完全成活率100%。轴心动脉经吻合支向远端供血,经静脉吻合支回流。血管吻合区以远的血流方向与术前相反。术后即刻VEGF免疫组化染色阴性;1天后血管吻合支与术前相比明显增多、增粗,蒂部血管口径明显增粗,VEGF免疫组化染色阳性区域较多;3天时上述指标达高峰;7天时形成与顺流皮瓣相似的轴心血管,蒂部血管口径有所下降,VEGF免疫组化染色阴性。结论:跨区供血皮瓣的成活机制为血管的口径增大及数量增多,最终形成轴形血管皮瓣。内源性VEGF对皮瓣的成活起重要作用。Objective To investigate the survival mechanisms of the reverse-flow flap. Methods Rectangle skin flaps based on the deep circumflex lilac vessel （DCIV）, which comprised the adjacent territory based on the posterior intercostal arteries （PIA）,were designed and elevated on the rat＇s right dorsum .The flaps were served as the reverseflow flaps model. The survival area, the vessels redistribution, the change of pedicle vessel＇s caliber, and VEGF immunohistochemistry were evaluated immediately, and on the 1st, 2nd, 3rd, 5th, 7th day after operation respectively. Results All flaps survived. Blood supplied by DCIV flowed to the distal and refluxed to the proximal through the vascular anastomosis between the two territories. The direction of blood flow in the distal territory run in a reversed pattern after operation. VEGF immunohistochemistry was negative immediately after operation. The caliber of vascular anastomosis and DCIV became obviously wider and the number of vascular anastomosis became conspicuously more 1 day after operation than that before operation, meanwhile, VEGF immunohistochemistry became active. All data reached to the peak 3 days after operation. On the 7th day, the vasculature ot the tlap became stmttar to mat OT [ne convenuona~ axial flap and the caliber of DCIV decreased, VEGF immunohistochemistry became negative. Conclusion The survival mechanism of the reverse-flow axial skin flap was the increased number and dilated caliber of vessels. In the end,the new vasculature of the flaps were similar to the conventional axial flaps. Endogenous VEGF play an important role in this process.

关 键 词：反流 轴形皮瓣 内源性 血管内皮细胞生长因子 

分 类 号：Q813.1[生物学—生物工程]