预构扩张皮瓣的实验研究

Experimental study on expanded prefabricated flaps

目的:研究预构扩张皮瓣的成活及其机制、微循环灌注量动态变化、超微结构改变。方法:选取成年雄性新西兰白兔36只,随机分为预构扩张组(A组)、扩张器衬垫预构组(B组)及预构组(C组),每组12只。股动静脉血管束移位后,前两组分别在肉膜深面植入50 ml扩张器,预构扩张组7 d后开始注水。定期对3组皮瓣进行微循环检测,并取样进行血管内皮细胞生长因子(VEGF)、碱性成纤维细胞生长因子(bF-GF)及其受体、光镜及超微结构的检测与观察。第52天扩张完成后,形成仅以预构血管为蒂的岛状皮瓣,观察记录成活面积。结果:A组微循环灌注量明显高于B、C组(P<0.05),皮瓣成活面积占原始皮瓣面积的百分比大于B、C组(P<0.05),VEGF、bFGF及其受体含量亦明显高于B、C组(P<0.05),血管密度加大,超微结构改变显著。结论:预构扩张皮瓣能增大皮瓣成活面积,增加皮瓣移植的安全性。VEGF、bFGF及其受体含量的增加促进预构扩张皮瓣血管化进程。

Objective： To investigate the survival of expanded prefabricated flaps and its mechanism, microcirculation and ultrastructural changes. Methods： A total of 36 New Zealand male rabbits were divided randomly into expanded prefabricated, expender lined and prefabricated groups. After the femoral vascular bundles were transplanted into the subcutaneous tissues of abdomen, expanders were implanted into the deeper dartos. For the expanded prefabricated group, the expansion was carried out at 7 days postoperatively; When the expander was fully expanded at 52 days, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by digital recording of survival area, laser Doppler flowmetry, immunhistochemistry, light microscope and electron microscope. Results： When compared with other groups, the blood flow enhanced; the flap survival improved; VEGF, bFGF, VEGFR and bFGFR increased; blood capillary was stronger, and the ultrastructure significantly changed in the expanded prefabricated groups. Conclusion： Expanded prefabricated flap is good in survival and safe in transplantation; the growth of VEGF, bFGF, VEGFR and bFGFR accelerates the neoangiogenesis of expanded prefabricated flaps.