预构组织瓣构建方法与血管化过程的研究与应用

Methods for constructing prefabrication of osteocutaneous flap and the application in vascularization

目的:组织瓣的预构是将符合受区要求的组织″造″可游离或岛状移改成植的轴型组织瓣,有较大的临床价值。介绍预构组织瓣的构建方法、血管化过程及其影响因素,以利于指导临床应用。资料来源:应用计算机检索Pubmed数据库1980-01/2005-08有关预构组织瓣的研究与应用的文章,检索词“prefabrication,prefabricated,fat,nerve,fascia,muscle”,限定文章语言种类为English。同时计算机检索中国期刊全文数据库、万方数据1994-01/2005-07期间的相关文章,检索词“预构皮瓣、预制、预构组织瓣”,限定文章语言种类为中文。资料选择:对资料进行初审,选取有关文章查找全文。纳入标准:①有关预构组织瓣的实验研究。②有关预构组织瓣的临床应用。排除标准:①重复研究。②较陈旧的文献。资料提炼:共收集到155篇有关预构组织瓣的实验研究和临床应用的文章,排除重复或类似的同一研究,选择符合要求的22篇综述。资料综合:①预构组织瓣的构建方法:一些新颖的血管载体如异体血管、滋养血管分布的骨、动脉化静脉等也被用于组织瓣的预构中,预构的对象除随意型皮瓣、脂肪、骨、神经、软骨-皮肤、肠管、复合组织器官等外,一些组织代用品和组织工程化器官也被血管化。②血管化过程及其影响因素:研究发现,供瓣区的血供条件、血管束植入的方式、血管载体的大小和类型、生长因子、扩张等均能影响预构组织瓣的血管化进程。③临床应用:旋髂深血管滋养的髂骨块、腹直肌、背阔肌、颞浅筋膜等作为血管载体,将随意型皮瓣、肠管、软骨-皮肤等预构成轴型组织瓣,满足了临床上的具体需要,其和扩张术的结合则既改善了修复效果,又减少了供区损害。④展望:随着细胞生物学、免疫学等相关学科的不断发展,有望在促进血管化进程和克服排异反应等方面获得新的突破,从而极大的缩短两次手术间隔期和有效利用异体血管。结论:近年来,预构组织瓣的预构范围有所扩大,所使用的血管载体也增添了新的内容,对预构组织瓣血管化过程及其影响因素的认识也得到了进一步的深化,临床上得以巧妙的应用,显示了一定的临床价值,当然,在一些方面还有待进一步研究。

OBJECTIVE： The prefabrication of osteocutaneous flap is to ＂reform＂ the tissue accorded with the requirement to axis-like osteocutaneous flap of free or island transplantation, which is of great clinical significance, This paper was to introduce the methods for constructing prefabrication of osteocutaneous flap, the process of vascularization and the influencing factors, so as to instruct the clinical application. DATA SOURCES： A computer-based online search of Medline database was undertaken to identify articles about the study and application of the prefabrication of osteocutaneous flap published in English between January 1980 and August 2005 with the keywords of ＂prefabrication, prefabricated, fat, nerve, fascia, muscle＂. Meanwhile, Chinese relevant articles published between January 1994 and July 2005 were retrieved in China National Knowledge Infrastructure （CNKI）, the keywords were ＂prefabrication of flap, prefabricated, prefabrication of osteocutaneous flap＂ in Chinese.STUDY SELECTION： The data were checked firstly, and the full-texts of relevant articles were searched. Inclusive criteria： ①experimental studies about the prefabrication of osteocutaneous flap; ② about the clinical application of the prefabrication of osteocutaneous flap. Exclusive criteria： ①repetitive studies; ② old studies. DATA EXTRACTION： Totally 150 articles about experimental study and clinical application of the prefabrication of osteocutaneous flap were collected, the repetitive or similar studies were deleted, and 22 articles accorded with the inclusive criteria were reviewed. DATA SYNTHESIS： ① Methods for constructing prefabrication of osteocutaneous flap： Some up-to-date vascular carriers, such as homologuous vessel, bone and arterialized vein that nourish vascular distribution, are used in the prefabrication of osteocutaneous flap. Besides random flap, fat, bone, nerve, cartilage-skin, intestinal canal, compound tissue organs, some tissue substitutes and tissue engineered organs are also vascularized. ②Process of vascularization and the influencing factors： The studies showed that the condition of blood supply, implanted pattern of vascular bundle, size and type of vascular carrier, growth factor and dilatation in the flap donator area can all affect the vascularized process of the prefabrication of osteocutaneous flap. ③Clinical application： The iliac one block, rectus abdominis, latissimus dorsi and superficial temporal fascia are taken as the vascular carriers to prefabricate the random flap, intestinal canal and cartilage-skin into axis-like osteocutaneous flap, which meets the clinical specific need, its combination with dilataltion not only ameliorates the repairing effect, but also decrease the damage of the donator area. ④Prospect： With the continuous development of cell biology and immunology, it is prospected that there will be new break through in accelerating yascularization and overcoming rejection, so as to shorten the interval between two operations and effectively use homologous vessel. CONCLUSION： In recent years, the prefabricated range of osteocutaneous flap has be enlarged, and there are new contents for the applied vascular carriers, the recognition to the vascularization of prefabricated osteocutaneous flap and the influencing factors also become deeper, and it is applied artfully in clinic, and show certain clinical significance. However, there are still some aspects needed further study.