兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Expanded prefabricated flaps of femoral artery and vein： an experimental study

目的通过兔股动脉、静脉预构轴型扩张皮瓣的微循环血流量动态变化、光镜下结构的改变及其成活面积，为预构轴型扩张皮瓣的临床应用提供依据。方法选择新西兰白兔40只，随机分为4组：预构轴型扩张皮瓣组、预构轴型不扩张皮瓣组、单纯预构轴型皮瓣组及无蒂游离皮瓣组，每组4只，前2组股动脉、静脉移位后，预构轴型扩张皮瓣组、预构轴型不扩张皮瓣组分别在肉膜深面置入容量为50ml长方形皮肤软组织扩张器，预构轴型扩张皮瓣组7d后开始注水；无蒂游离皮瓣组为对照组，未采取预构及扩张处理。定期对4组皮肤进行微循环血流量检测，并取样进行光镜观察。预构术后52d，前3组形成以预构股动静脉血管束为蒂的岛状皮瓣，游离皮瓣组则形成无蒂游离皮瓣后均原位缝合，观察其成活面积。结果预构轴型扩张皮瓣组较其他组微循环血流量增加，成活面积大[（97．54±2．73）％]，光镜下改变显著（P〈0．05）。结论扩张术能促进预构轴型皮瓣的血管化进程，明显增大预构轴型皮瓣成活面积，增加其移植的安全性。

Objective To study the rnicrocirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital recording of survival area. Results When compared with the other groups, the perfusion volume of microeirculation enhanced, flaps survival improved （97.54±2.73）%, blood capillary were stronger, together with microscopic changes were significant in the expanded prefabricated groups （P〈0. 05）. Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.