逆行岛状皮瓣“迷宫”静脉回流途径的实验研究

An experimental study of "bypass route" in venous drainage of reverse-flow island flaps

目的:以新西兰大白兔隐动静脉逆行岛状皮瓣为模型,探讨逆行岛状皮瓣中"迷宫"静脉回流途径的作用。方法:在兔后肢内侧设计切取隐动静脉逆行岛状皮瓣(面积3cm×3cm,蒂长4cm,蒂部含1cm宽筋膜),每组10个皮瓣,进行同体对照。对照组:血管蒂部不做处理,即保留"瓣膜失效"和"迷宫"两种回流途径;实验组:于血管蒂正中位置结扎两伴行静脉干,即阻断"瓣膜失效"途径。放松止血带后,连续测定1h内大隐静脉压力。术后1周测定皮瓣成活率。动物处死后蒂部组织学观察。结果:(1)测定10、20、30、40、50、60min的大隐静脉压平均值,对照组为:29.24、29.01、27.24、25.67、24.98、24.84mmHg;实验组为:37.16、36.70、37.07、36.82、35.33、37.56mmHg。在各个时间点,实验组均明显高于对照组(P<0.01)。(2)术后1周两组皮瓣平均成活率比较,对照组为(97.09±3.12)%>实验组为(87.51±13.74)%(t=2.26,P<0.05)。(3)两组皮瓣蒂部均有散在分布的扩张小静脉,实验组要多于对照组。结论:(1)"迷宫"途径较"瓣膜失效"途径更难于实现静脉逆流。(2)逆行岛状皮瓣的静脉回流以"瓣膜失效"途径为主要方式,"迷宫"途径起辅助作用。

Objective： To investigate the efficacy of＂bypass route＂ in venous drainage of reverse-flow island flaps with a model of rabbit saphenous reverse-flow island fasciocutaneous flaps. Methods： The saphenous reverse-flow island fasciocutaneous flap（3.0 cm×3.0 cm in size with vascular pedicle length of 4.0cm containing connective tissue width of 1.0 cm） was successfully established in New Zealand White rabbit. Limbs of 10 rabbits were allocated into two groups of 10 flaps. In group Ⅰ, the vascular pedicle was maintained intact. In group Ⅱ, the two venae comitantes was ligated cling to wall of veins at middle part of the vascular pedicle and do the connective tissue was maintained intact, lntrovenous pressure was measured for one hour after the tourniquet released. Flap survival rate was measured in one week. The vascular pedicle was harvested and observed histologically. Results： In group I, the values of intravenous pressure interval of 10 minutes in measured time are 29.24, 29.01, 27.24, 25.67, 24.98, 24.84 mmHg, and in group Ⅱ, they are 37.16, 36.70, 37.07, 36.82, 35.33, 37.56 mmHg. The values of group Ⅱwere significantly higher （P 〈0.01） than those of group Ⅰ in every times. And flap survival rate of group Ⅰ（97.09±3.12）% is higher than that of group Ⅱ （87.51±13.74）%（t=-2.26, P 〈0.05）. Histological examination showed there are lots of dilated venules in both proximal and distal of vascular pedicle. Especially, amount of dilated venules in group Ⅱis more than that in group Ⅰ. Conclusion： Venous retrograde return in reverse-flow island flaps can be achieved more difficult through ＂bypass route＂ than through ＂incompetent valves route＂. The main way of venous drainage of reverse-flow island flaps is ＂incompetent valve route＂, and ＂bypass route＂ plays a complementary role.