跨区供血皮瓣早期血流动力学基本规律理论研究  

A mathematical model and deduction describing the basic rules of hemodynamics of the multi-territory flap in the early stage

作　　者：陶友伦[1] 丁茂超 习珊珊[4] 毛以华 王建红 张述才[1] 常步青 郝云甲[1] 范家强 冯仕明[1] 张在轶[1] 王爱国[1] Tao Youlun;Ding Maochao;Xi Shanshan;Mao Yihua;Wang Jianhong;Zhang Shucai;Chang Buqing;Hao Yunjia;Fan Jiaqiang;Feng Shiming;Zhang Zaiyi;Wang Aiguo(Department of Orthopedics Surgery,Xuzhou Central Hospital,Xuzhou Clinical School of Xuzhou Medical University,Xuzhou 221009,China;Institute of Clinical Applied Anatomy,School of Basic Medicine,Wenzhou Medical University,Wenzhou 325035,China;Department of Human Anatomy,Wenzhou Medical University,Wenzhou 325035,China;Department of Human Anatomy,Yangtze University School of Medicine,Jingzhou 434023,China;Department of Pediatric Surgery,Ningbo University School of Medicine,Ningbo 315000,China)

机构地区：[1]徐州市中心医院骨科,徐州医科大学徐州临床学院,徐州221009 [2]温州医科大学基础医学院临床应用解剖研究所,温州325035 [3]温州医科大学人体解剖学教研室,温州325035 [4]长江大学医学部人体解剖学教研室,荆州434023 [5]宁波大学附属医院小儿外科,宁波315000

出　　处：《中华整形外科杂志》2022年第7期814-820,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探究跨区供血皮瓣早期血流动力学基本规律。方法以游离皮瓣和带血管蒂转位皮瓣为原型,以血管体区理论为基础,参照流体力学、电流学等相关知识,系统分析皮瓣内血流通路、阻力网络及其串联或并联方式,最后利用数理模型进行推演。结果跨区供血皮瓣早期动脉和静脉内可实现流量动态平衡,皮瓣可分为有效循环区、静脉淤滞区、相对缺血区和绝对缺血区。并且推导出:(1)血管蒂的血流为压力恒定,而不是流量恒定;(2)皮瓣的阻力因动、静脉血管蒂的位置或其二者的相对位置的变化而改变;(3)皮瓣从蒂部到远端其血流速度逐渐递减;(4)导致皮瓣远端坏死的主要因素因其所处的区域而异。结论跨区供血皮瓣早期血流动力学变化规律及特点可以通过该数理模型进行阐释,早期皮瓣动、静脉可以达到流量的动态平衡,并且血流量由蒂部至远端逐渐递减,皮瓣的成活范围依赖于动、静脉内的压力差及其皮瓣内血流通路的阻力,皮瓣远端坏死区可分为静脉淤滞区和动脉供血不足区。Objective To explore the basic rules of hemodynamics of the multi-territory flap in the early stage.Methods In this paper,based on the prototype of the free flaps and vascularized pedicled transpositional flaps.The angiosome theory was applied as a basis to systematically analyze the blood flow pathway,the resistance network,and the series or parallel connection mode between each resistance network within the flap,according to the knowledge of fluid mechanics and current pathway,and finally the mathematical model was used for deduction.Results Based on the model,it can be concluded that a dynamic flow balance can be achieved in the arteries and veins of the multi-territory flap in the early stage and the flap could be divided into four areas:the effective microcirculation zone,the venous stasis zone,the relative ischemic zone and the absolute ischemic zone.And the following inferences can be drawn:(1)The blood supply to the vascular pedicle is constant by pressure rather than by flow.(2)The resistance of the flap varies by the position or the relative position of the arterial vascular pedicle and venous vascular pedicle.(3)The flow velocity decrease gradually from the pedicle to the distal end.(4)The main factors that lead to distal flap necrosis vary depending on the region in which they are located:the venous stasis zone is mainly due to obstructed venous return,and the relative and absolute ischemic zones are mainly due to insufficient arterial blood supply.Conclusions The basic rules and characteristics of hemodynamics of the multi-territory flap in the early stage can be well explained by this theoretical model,the pedicled artery and vein of the flap can achieve a dynamic balance of flow,and the blood flow gradually decreases from the pedicle to the distal end.The survival range of the flap depends on the pressure difference between the artery and vein as well as the resistance of the blood flow path in the flaps.The distal necrotic area of the flap can be divided into venous stasis area and arterial insuff

关 键 词：血流动力学 跨区供血皮瓣 血流量 理论模型 

分 类 号：R622[医药卫生—整形外科]