以主干血管及筋膜皮肤为蒂的兔逆行岛状皮瓣的研究  

Experimental research of reverse island flaps in fasciocutaueous - pedicled form in rabbit model

作　　者：刘继军[1] 郑磊[1] 唐超[1] 

机构地区：[1]河南省人民医院骨科,郑州450003

出　　处：《中华实验外科杂志》2017年第10期1751-1753,共3页Chinese Journal of Experimental Surgery

基　　金：河南省科技厅基础与前沿资助项目（132300410417.0）

摘　　要：目的探讨以主干血管及筋膜皮肤为蒂的逆行岛状皮瓣的皮肤筋膜蒂对皮瓣成活影响及其在皮瓣静脉回流中作用。方法选用健康新西兰大白兔12只，以蒂部情况不同分为g组：A组皮瓣皮肤筋膜蒂宽设计为0cm，B组皮瓣皮肤筋膜蒂宽设计为0．5cm，C组皮瓣皮肤筋膜蒂宽设计为1．5cm，D组皮瓣皮肤筋膜蒂宽设计为1．5cm（蒂部仅含隐动脉，于旋转点处结扎伴行的隐静脉），蒂长均为3．0cm，以踝关节线上2．0cm为旋转点，皮瓣大小均设计为7．0cm×3．0cm。切取皮瓣，观察记录术后皮瓣成活情况。应用SPSS17．0统计软件分析。并行亚甲蓝灌注观察研究不同蒂部处理方式的皮瓣的静脉回流。结果蒂部不同处理方式的兔隐血管逆行岛状皮瓣共24例（每组6例）。A组：3只皮瓣完全成活；3只皮瓣近端发生部分坏死，平均成活面积百分率为85．57％。B组：4只皮瓣完全成活；2只皮瓣近端发生部分坏死，平均成活面积百分率为88．10％。C组：6只皮瓣均完全成活。D组：4只皮瓣完全成活；1只皮瓣发生部分坏死，1例皮瓣全部坏死，平均成活面积百分率为73．83％。在A、B、C3组，随着蒂部筋膜皮肤组织宽度增加，皮瓣坏死例数逐渐降低，皮瓣成活面积比率递增。A、B、c、D4组间两两比较，差异无统计学意义。亚甲蓝灌注可见筋膜皮肤蒂部存在较多的“迷宫式”静脉吻合及静脉穿支间吻合。结论隐血管蒂周围带一定宽度筋膜皮肤蒂对兔隐血管逆行岛状皮瓣的成活有一定的改善作用。静脉回流主要通过主干静脉的逆静脉瓣回流，筋膜皮肤蒂对皮瓣的静脉回流起部分作用。Objective To explore the influence of the fasciocutaneous pedicle on the survival of the reverse island flaps and the role of the faseiocutaneous pedicle in the venous return of the flap. Methods According to the different pedicles, 12 New Zealand rabbits were divided into four groups ： group A （ retro- grade island flap without faseiocutaneous pedicle ） ; group B （ retrograde island flap with 0. 5 - cm - wide fascioeutaneous pedicle） ; group C （retrograde island flap with 1.5 -cm- wide fasciocutaneous pedicle） ; group D （ retrograde island flap with 1.5 - cm - wide fasciocutaneous pedicle but without saphenous vein）. All the flaps were designed with the dimension of 7.0 cm x 3.0 cm, the pediele length of 3.0 cm, and the pivot point locating at 2. 0 cm above the medial malleolus. On the postoperative day 7 to 10 day, the sur- vival rate of all the flaps was recorded. All the data were analyzed by SPSS 17.0. The venous drainage of various flaps was observed and recorded when the flaps were injected with methylene blue. Results Twenty -four retrograde island flaps with various pedieles were divided into four groups （6 flaps in each group）. In group A, 3 flaps survived uneventfully and the rest 3 flaps developed partial necrosis, and the average survival rate was 85.57%. In group B, 4 flaps survived uneventfully and the rest 2 flaps developed partial necrosis, and the average survival rate was 88. 10%. In group C, all the flaps survived uneventfully and no flap developed partial necrosis. In group D, 4 flaps survived uneventfully, one flap developed par- tial necrosis, complete necrosis occurred in one flap, and the average survival rate was 73.83%. Compari- son between every two groups was performed using Mann - Whitney U test, and there was no significant difference in the survival rate. Among groups A, B and C, the survival rate increased along with the in- creased width of the faseiocutaneous pediele. Through the injection of methylene blue, ＂puzzle＂ anastomo- sis and anastomosis betwee

关 键 词：岛状皮瓣 筋膜皮瓣 皮瓣蒂部 兔 

分 类 号：R622[医药卫生—整形外科]