荧光皮肤血流仪在猪皮肤撕脱伤撕脱皮瓣血循环判断中的应用

Application of demofluorometer in survival prediction of avulsed skin flap of porcine suffered from skin avulsion

目的:探讨荧光皮肤血流仪在皮肤撕脱伤撕脱组织血循环判断中的应用。方法:选择检疫后的白色小猪为实验动物,于猪后肢通过手术形成一12cm×4cm的任意型皮瓣,掀起皮瓣后原位缝回。术后猪耳缘静脉注射荧光素钠,20min后用荧光皮肤血流仪检测皮瓣不同部位荧光强度,计算荧光强度指数(Dye fluorescence index,DFI)。一周后观察皮瓣成活情况,计算皮瓣成活与坏死的面积,分析DFI数值与皮瓣组织活力间的关系,探索荧光皮肤血流仪对猪皮瓣血循环的判断规律;在此基础上,复制皮肤撕脱伤模型,分别用荧光皮肤血流仪和传统荧光法对撕脱皮瓣组织坏死面积进行预测,对比分析二者预测的准确性。结果:一周后皮瓣远端发生坏死,近端成活良好,平均坏死面积为43%,平均成活面积57%;成活区域DFI平均值为62%,坏死区域DFI平均值为11%,两者有统计学差异(P<0.01)。统计分析显示,DFI≤18%时,组织可能发生坏死。荧光皮肤血流仪对坏死面积预测的误差为12%,传统荧光法为23%,两者有统计学差异(P<0.01)。结论:荧光皮肤血流仪DFI与猪皮瓣血循环灌注有良好的对应关系,它可以对猪皮肤撕脱伤撕脱皮瓣活力做出更为准确的判断。

Objective To explore application of demofluorometer in assessment on blood circulation of avulsed tissues of porcine suffered from skin avulsion injury. Methods Seven little white pigs after quarantine were chosen as experimental animals, and seven random skin flaps of 12 cm×4cm on hind leg of pigs were elevated individually and sutured in the same place. After operation, fluorescein sodium was administrated by intravenous injection, and fluorescence intensity in different parts of every skin flap was detected by demofluorometer at the 20th min after administration, then DFI was calculated. 7 days later, the percentage of survival and necrotic skin flap areas was calculated, then the relation between DFI and tissues vitality of avulsed skin flap was analyzed in order to research blood circulation＇s estimative index of demofluorometer. On the base of that, the models of skin avulsed injury were reproduced. Demofiuorometer and traditional fluorescence method were used respectively to predict the areas of necrotic tissues in avulsed skin flap, then the accuracy of them was compared and analyzed. Results One week later, distant part of skin flaps happened to be necrotic, while proximal part were viable. The pencentage of necrotic areas was 43%, while that of survival areas was 57%; the average value of DFI in survival areas was 62%, while that in necrotic areas was 11%, between which there was difference in statistics （P〈0.01）. Statistical analysis showed that tissues could be necrotic while DFI ≤ 18%. The error rate of prediction by demofluorometer on necrotic tissues was 12%, while that by traditional fluorescence method was 23%, between which there was difference in statistics （P〈0.01）. Conclusion DFI of the demofluorometer could correspond to the blood circulation perfusion of porcine skin flaps very well. The demofluorometer could assess on the vitality of avulsed skin flaps of porcine suffered from skin avulsion injury more accurately.