线扎逐步缩窄蒂部法行皮瓣早期断蒂的实验研究及临床应用

Experimental study and clinical application of early pedicle division of skin flap by ligation

目的探讨线扎逐步缩窄蒂部法行皮瓣早期断蒂的可行性和临床应用效果。方法用20只新西兰大白兔背部两侧各制作两块随意型皮瓣(8·0cm×4·0cm),一侧皮瓣蒂部横行缝数对丝线为实验组,另一侧为对照组。于术后第3天开始结扎实验组皮瓣蒂部两侧两对丝线,第5天蒂部全段结扎,第6天所有皮瓣断蒂,断蒂3d后测定皮瓣成活面积,并分别于术后第4、6天取皮瓣组织标本切片染色后进行组织学观察。另外,在临床上对78块随意型带蒂皮瓣采用丝线结扎、逐步缩窄蒂部后断蒂。结果断蒂后实验组皮瓣成活率明显高于对照组;组织切片显示皮瓣蒂部结扎后,皮瓣内因缺血致血管密度、管径均增大。临床病例皮瓣平均断蒂时间缩短至术后10d,断蒂后皮瓣无一例坏死。结论本方法简便易行,安全可靠,可以缩短皮瓣的断蒂时间。

Objective To establish a new method of early cut-off skin flap by ligating to stegnosis pedicle and assess its feasibility and clinical application. Methods Twenty New Zealand rabbits were used to make skin flaps with the size of 8.0 cm × 4. 0 cm on both sides of the back respectively. And one side was experimental group with the pedicles of skin flaps horizontally oversewn by several pairs of silk thread, the other side was control group. Two pairs of silk thread in the two sides of the pedicle of skin flap of experimental group were ligated on the 3rd day. On the 5th day the pedicle was wholly ligated. All pedicles were divided on the 6th day and the survival area of skin flaps were measured after 3 days. The tissue samples from the skin flaps were collected for histology test on the 4^th and 6^th day respectively. The pedicles of 78 random flaps from 48 patients were cut off after narrowing them by ligating. Results The mean flap survival rate of the experimental group was statistically higher than the control group. Histological examination results showed the density and diameter of blood vessel were increased in the skin flaps of the experimental group. The mean time for removal pedicles was shortened to 10 days, and no necrosis was found after resecting. Conclusions This method is secure and convenient and the time of pedicle division can be shortened.