动脉化静脉皮瓣两种灌流方式比较的实验研究及临床应用

Comparison between two types of in-and outflow arterialized venous flap:an experimental study and clinical application

目的探讨两种不同灌流方式对游离动脉化静脉皮瓣存活效果的影响。方法将20只日本大耳白兔40侧后肢建立成吻合股动、静脉浅支的动脉化静脉皮瓣模型。采用自身对照,实验组为逆静脉瓣供血顺静脉瓣回流,对照组为顺静脉瓣供血逆静脉瓣回流。临床上采用逆静脉瓣供血顺静脉瓣回流方式的皮瓣5例。结果实验组皮瓣存活16侧,部分存活2侧,坏死2侧。对照组皮瓣存活6侧,部分存活11侧,坏死3侧。两组差异有统计学意义(P＜0．05)。临床应用5例,4例完全存活,1例表皮坏死,脱痂后愈合。结论建立适当的供血与回流比例是动脉化静脉皮瓣存活的关键,保证供血前提下增加静脉回流能提高动脉化静脉皮瓣的存活率。如果不能增加回流,减少超量的供血可提高皮瓣的存活。

Objective To evaluate the influence of two types of perfusion on the survival of arteriallzed venous flaps. Methods A.rterialized venous flap was set up in 40 hind limbs of 20 Japanese white rabbits by anastomosing the femoral artery to the femoral vein. Those flaps were randomly divided into two groups： anti-valve-inflow and provalve-outflow, and pro-valve-inflow and anti-valve-outflow. The anti-valve-inflow and pro-valve-outflow construct was applied in 5 cases clinically. Survival of the flaps were recorded. Results In the anti-valve-inflow and pro-valveoutflow group 16 flaps survived, while 2 flaps had partial necrosis and 2 flaps of complete necrosis. In the pro-valve- inflow and anti-valve-outflow group 6 flaps survived, while 11 had partial necrosis and 3 complete necrosis. There was significant difference in the survival rate between the two groups （ P 〈 0.05 ）. In the 5 clinic cases of arterlalized venous flap, 4 had complete flap survival and 1 cases had superficial necrosis that healed with dress change. Conclusion The key for survival of arterialized venous flaps is the proportion of in-and outflow. Amelioration of venous drainage may improve the survival rate of arteriallzed venous flap when arterial supply is enough. Reduction of overflowing arterial supply may improve the survival if venous drainage can not be ameliorated.