两种腓肠神经小隐静脉远端蒂皮瓣成活率的比较

Comparison of survival rate in two kinds of lesser saphenous sural pedicled fasciocutanous flaps

目的比较两种腓肠神经小隐静脉岛状筋膜皮瓣成活率并探讨皮瓣静脉回流。方法将10只新西兰大白兔随机分为两组,每组5只10个皮瓣。A组采用小隐静脉腓肠神经筋膜蒂皮瓣(节段穿支动脉伴行);B组采用小隐静脉腓肠神经筋膜蒂皮瓣(轴性动脉伴行)。观察两组皮瓣的成活情况并取蒂部组织行组织学观察。结果A组皮瓣成活率为(15.2±16.7)%,B组皮瓣成活率为(94.1±6.4)%,两组间差异有统计学意义(P<0.001)。蒂部组织学观察显示,A组蒂部由小隐静脉、腓肠神经、小的穿动脉及周围结缔组织构成,小隐静脉腔形成大的血栓;B组蒂部包含小隐静脉、腓肠神经、腓肠浅动脉及结缔组织,小隐静脉通畅未见血栓。结论有轴性伴行动脉的小隐静脉腓肠神经筋膜蒂皮瓣成活率高,静脉容易回流。

Objective To compare the survival rate of two kinds of neurovenofasciocutaneous flaps and investigate the venous reverse flow of flaps. Methods Ten New Zealand White rabbits were randomly allocated into 2 groups of 10 flaps （ group A ： the lesser saphenous sural pedicled fasciocutanous flaps, blood supply provided with perforator arteries ; group B ： the lesser saphenous sural pedicled fasciocutanous flaps, blood supply provided with axial type artery）. The survival rate of flaps in two groups was observed. Pedicles of flaps were harvested and examined histologically. Results The survival rate of flaps in group A was significantly lower than that in group B[ （ 15.2 ±16.7） % vs （94.1±6.4） % , P 〈0. 001 ]. It was revealed by histological examination that the pedicles in group A consisted of lesser saphenous veins, sural nerves, perforators arteries and connective tissues, and those in group B consisted of lesser saphenous veins, sural nerves, superficial sural arteries and connective tissues. Moreover, lumina of lesser saphenous vein in group A were filled with thrombosis, while there was no obstruction in those of group B. Conclusion The lesser saphenous sural pedicled fasciocutanous flaps accompanying with axial arteries have higher survival rates and the venous reverse flow of flaps is facilitated.