摘要
为探讨指背旗形皮瓣的成活机理,应用恒河猴1只,做了8个指背旗形皮瓣的实验,其中近端蒂6个,远端蒂2个。术后作系统的肉眼摄像、激光多普勒血流测定和组织分段切片观察。结果显示:①与皮瓣的长:宽为10∶1时,仍能成活,且无发紫、水肿出现。②术后前2天皮瓣的激光多普勒测定值较术前水平稍有下降.但不明显(P>0.05),术后第3天开始,血流测定值逐渐上升,于第5天达到或超过术前水平。③皮瓣成活后组织分段切片表明,指背旗形皮瓣的蒂部无知名的动脉血管,但含有丰富的指背静脉。由此认为指背旗形皮瓣实为一种静脉皮瓣,其保留的静脉周围组织中的微动脉血管能给皮瓣以血上供,而指背静脉提供丰富的静脉回流通道。在此基础上,临床应用20个指背旗形皮瓣修复了手指皮肤缺损合并骨、肌腱外露者12例,获得满意效果。
To investigate the survival mechanism of the dorsal digital flag flap,an animal experi- ment was undertaken in a monkey.Eight dorsal digital flag flaps were created and examined by clinical observations,laser Doppler and biopsy.Of them six flaps were proximal-based and two were distal- based.The results showed:①The flag flaps survived without purplish discoloration or blister forma- tion when the length-width ratio reached 10:1;②The perfusion unit measured by laser Doppler flowmetry decreased on the second postoperative day and began to increase from the third day,and re- turned to or surpass the preoperative level on the fifth day;③Biopsies confirmed that there was no spe- cific artery in the pedicle of the flag flap but a rich dorsal digital venous network.The results indicated that the flag flap is a venous flap.Its arterial perfusion passed through the perivenous vascular network of the pedicle while the venous drainage is through the dorsal digital veins.Based on this study,20 ve- nous dorsal digital flag flaps have been used for reconstruction of digital defects associated with expo- sure of bone or tendon in 12 patients.Satisfactory results were obtained in all cases.
