A型肉毒毒素和硫酸镁对大鼠随意型皮瓣成活的影响  

Effect of botulinum toxin type A and magnesium sulfate on random-pattern skin flap survival in rats

作　　者：许熙 胡金鹏 张伟[1] 李心怡[1] 李小静[1] Xu Xi;Hu Jinpeng;Zhang Wei;Li Xinyi;Li Xiaojing(Department of Plastic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院整形外科,合肥230022

出　　处：《中华整形外科杂志》2024年第11期1157-1167,共11页Chinese Journal of Plastic Surgery

基　　金：合肥市医疗卫生“借转补”研发项目(J2020Y02);安徽医科大学研究生科研与实践创新项目(YJS20230120)。

摘　　要：目的探讨A型肉毒毒素和硫酸镁对不同长宽比的随意型皮瓣成活率的影响。方法采用随机数字表法将45只SD大鼠分为3组:生理盐水组(A组)、A型肉毒毒素组(B组)、硫酸镁组(C组),每组15只。每组根据不同长宽比(1∶1、2∶1、3∶1)的随意型皮瓣设计再分为3个亚组,每组5只大鼠。随意型皮瓣的制备:以鼠背部正中线为轴,以髂嵴连线下1 cm水平线为蒂部,向头侧延伸,切开皮肤组织至背部筋膜,于深筋膜浅层分离皮下组织,切断两侧及基底的血管及其分支,止血后原位缝合。术后即刻在A、B、C 3组皮瓣近、中、远端分别注射生理盐水、A型肉毒毒素(25 U/ml)、硫酸镁溶液(50 mg/ml)各0.2 ml。术后第7天肉眼观察皮瓣大体外观,计算皮瓣成活率;切取皮瓣存活区域组织,行HE染色,观察微血管密度(MVD)及管腔扩张情况(血管外径、血管内径、管腔厚度);采用免疫组织化学法检测血管内皮生长因子(VEGF)的表达水平。采用GraphPad Prism 9.0.1软件进行统计分析,计量资料用±s表示,多组间比较采用单因素方差分析,组间两两比较采用Tukey检验。结果术后第7天,长宽比为1∶1的各亚组皮瓣均愈合良好。在长宽比为2∶1的皮瓣中,A组出现皮瓣远端部分坏死,皮瓣结痂发黑,无弹性,可见组织液渗出;B组和C组大部分愈合良好。在长宽比为3∶1的皮瓣中,A组皮瓣的中端和远端出现大面积坏死,坏死部分结痂发黑,无弹性,切割不出血,并见组织液渗出;B组和C组仅远端出现部分发黑,大部分愈合良好。3组长宽比为1∶1的皮瓣成活率差异无统计学意义(P>0.05);与A组相比,B组和C组长宽比为2∶1和3∶1的皮瓣成活率更高,差异有统计学意义(P均<0.01),B、C组间差异无统计学意义(P>0.05)。HE染色显示,随着随意型皮瓣长宽比的增加,各组皮瓣组织内水肿及炎症细胞浸润增多,B组和C组的组织炎性改变较A组明显减轻,且可见更多的新生微Objective To investigate the effects of botulinum toxin type A(BTX-A)and magnesium sulfate on the survival rate of random-pattern skin flaps(RSF)with different length-to-width ratios.Methods Using a random number table method,45 SD rats were divided into three groups:the saline group(Group A),the BTX-A group(Group B),and the magnesium sulfate group(Group C),with 15 rats in each group.Each group was further subdivided into three subgroups based on different length-to-width ratios of RSF(1∶1,2∶1,3∶1),with 5 rats in each subgroup.The preparation of the RSF involved using the midline of the rat’s back as the axis and the level 1 cm below the iliac crest line as the base,extending towards the head.The skin tissue was incised to the dorsal fascia layer,separating the subcutaneous tissue at the superficial layer of the deep fascia,while severing the blood vessels and their branches on both sides and at the base.After hemostasis,the flap was sutured in place.Immediately after surgery,0.2 ml of saline,BTX-A(25 U/ml),or magnesium sulfate solution(50 mg/ml)was injected into the proximal,middle,and distal ends of the flap.On the seventh day post-surgery,the gross appearance of the flap was assessed,and the survival rate was calculated.The surviving flap tissue underwent hematoxylin and eosin(HE)staining to evaluate microvascular density(MVD)and the degree of vasodilation(including vessel outer diameter,inner diameter,and wall thickness).Immunohistochemistry was used to detect the expression level of vascular endothelial growth factor(VEGF).Statistical analysis was performed using GraphPad Prism 9.0.1 software,with data expressed as Mean±SD.One-way ANOVA was used for multiple group comparisons,and Tukey’s test was used for pairwise comparisons.Results On the seventh day post-surgery,flaps with a length-to-width ratio of 1∶1 healed well in all subgroups.In the case of flaps with a 2∶1 ratio,Group A exhibited partial necrosis at the distal end,characterized by blackened,non-elastic scabs and exudate.Groups B and

关 键 词：外科皮瓣 随意型皮瓣 A型肉毒毒素 硫酸镁 血管内皮生长因子 大鼠 

分 类 号：R622[医药卫生—整形外科]