胫后血管顺、逆行皮瓣分别携带游离皮瓣动脉压及血流量动态变化

Haemodynamic studies on the anterograde/retrograde posterior tibial vascular flap and the carried free flap

目的：研究胫后血管顺、逆行皮瓣分别携带游离皮瓣移植的血流动力学及血流量动态变化，探讨此术式的血供规律。方法：在对兔后肢血管形态学研究基础上，以兔胫后血管制备出顺、逆行皮瓣桥并携带游离皮瓣的摹拟术式实验模型。分别进行兔胫后血管切断前ＭＡＰ测定、顺逆行皮瓣桥动脉压及脉压差测定、顺逆行皮瓣桥及所携带游离皮瓣血流量测定。结果：顺行皮瓣桥ＭＡＰ及脉压差术后即刻轻微下降，逆行皮瓣桥ＭＡＰ及脉压差术后即刻显著下降（Ｐ＜０．０５），１ｈ后渐趋正常（Ｐ＞０．０５），顺行与逆行皮瓣桥及所携带的游离皮瓣血流量动态变化一致（Ｐ＞０．０５），顺、逆行皮瓣桥与所携带的游离皮瓣在各自时间点动态变化均无显著性差异（Ｐ＞０．０５）。结论：逆行皮瓣供血具有血流动力学基础，顺、逆行皮瓣桥可作为血管蒂携带游离组织移植。

bjective:To study the dynamic changes of the mean arterial pressure,the pulse pressure,and the blood flow of the anterograde/retrograde posterior tibial vascular flap (A/RPTVF) and the carried free flap (CFF). Methods:Based on the morphologic observation of the blood vessels in rabbit posterior legs,an experimental model with the rabbit posterior tibial vessels was set up to simulate the clinical operation with A/RPTVF and CFF.The mean arterial pressures of the rabbit posterior tibial artery and the A/RPTVF,the pulse pressure of the A/RPTVF,and the blood flows to both A/RPTVF and the CFF were measured dynamicly.Results:Significant decreases(P<0.05) of the mean arterial pressure and pulse pressure were measured immediately in RPTVF,while tiny decreases were recorded in APTVF,and they returned to normal within 1 hour.Blood flows to both the A/RPTVF and the CFF decreased significantly after the operation and changed simultaneously at all postoperative time intervals.Conclusions:Based on the haemodynamic studies,both APTVF and RPTVF could be used as vascular pedicles in free flap transplantation.