不同蒂型静脉皮瓣的成活力

Viability of venous flap with different pedicle styles

背景:静脉皮瓣在临床应用方面有着动脉皮瓣所不具备的优点,但其一直存在着成活率较差的缺点,限制了其在临床上的应用。目的:构建不同模式静脉蒂的静脉皮瓣模型,以选择最佳蒂型,使皮瓣微循环得到有效灌注以及充分静脉回流,维持皮瓣内血液良好的灌流平衡,以得到有效提高静脉皮瓣成活率的可能方法和途径。设计、时间及地点:细胞形态学水平的对比实验,于2008-03/06在南华大学实验动物部完成。材料:选用健康雄性新西兰大白兔48只,按随机数字表法分为4组,即单蒂无输出型组、双蒂主干输出型组、双蒂属支输出型组及三蒂属支输出型组,每组12只。方法:在侧腹壁设计大小为8cm×5cm的一椭圆形皮瓣,分别制成4种不同类型的静脉皮瓣。各组皮瓣均保留腹壁浅静脉远端对皮瓣进行灌注,单蒂无输出型组所有输出静脉均切断、结扎,仅有1个静脉输入端;双蒂主干输出型组保留近心端浅静脉干输出;双蒂属支输出型组在近心端保留1支属支静脉输出;三蒂属支输出型组保留2支属支静脉输出。主要观察指标:皮瓣的成活情况,皮瓣组织学及细胞超微结构观察结果。结果:单蒂无输出型组、双蒂主干输出型组、双蒂属支输出型组、三蒂属支输出型组皮瓣成活率依次增高,除双蒂属支输出型组、三蒂属支输出型组之间差异无显著性意义外,其余各组间差异均有显著性意义(P<0.05)。三蒂属支输出型组皮瓣光镜下组织结构基本正常;透射电镜检查,大部分细胞结构趋于正常,胞浆内线粒体、内质网结构较清楚,细胞间连接较清楚,偶见线立体的空泡样变,数量少,核正常。三蒂属支输出型组皮瓣与其他各组组织学及细胞超微结构观察结果比较,均有明显差异。结论:静脉蒂直接影响皮瓣的成活,采用静脉干属支输出能够明显提高静脉皮瓣的成活率。保留合适的蒂型能保持静脉皮瓣的灌流平衡,进而提高静脉皮瓣的成活率。

BACKGROUND：Venous flap has some unique advantages not available in the artery flap.However,the poor viability of venous flaps limits their clinical applications.OBJECTIVE：To compare the venous flap model with different number and mode pedicle styles,choose the best one to make the flap effectively perfusion and sufficiently venous drained,and to search for an effectively way that can probably improve the viability of venous flap by keeping the balance of perfusion-drainage of the flap.DESIGN,TIME AND SETTING：The contrast observation of cell morphology was completed in the Laboratory Animal Center of Nanhua University from March to June 2008.MATERIALS：A total of 48 healthy,New Zealand white rabbits,were randomly divided into the single-pedicle flap without out-flow,the double-pedicle flap with trunk out-flow,the double-pedicle flap with tributary out-flow and the tri-pedicle flap with tributary out-flow groups,with 12 animals in each group.METHODS：An oval-shaped flap with size of 8 × 5 cm in the lateral abdominal wall was prepared for 4 types of venous flaps.In each group,the superficial vein distal of abdominal wall was retained for perfusion.In the single-pedicle flap without out-flow group,all the out-flow vein was cut down;in the double-pedicle flap with trunk out-flow group,superficial venous trunks was remained;in the double-pedicle flap with tributary out-flow group,1 tributary vein was remained;in the tri-pedicle flap with tributary out-flow group,2 tributary veins was remained.MAIN OUTCOME MEASURES：The survival of flap,as well as the histological and ultrastructure observation.RESULTS：The viability was in turn increased from the single-pedicle flap without out-flow group to the tri-pedicle flap with tributary out-flow group.There was no statistical significance between the double-pedicle flap with tributary out-flow and tri-pedicle flap with tributary out-flow group,but the inter-group difference was significant in the remaining groups（P〈0.05）.In the morphological examination,the organizational structure in tri-pedicle flap with tributary out-flow group was normal.In the transmission electron microscopy examination,the majority of cells in tri-pedicle flap with tributary out-flow group tended to be normal,and the mitochondria and endoplasmic reticulum within the cytoplasm were clear.It was occasionally that the vacuole-like mitochondria could be discovered,meanwhile the nucleolus was normal and the cell junction was clear.Taken together with the other group,the differences were obvious.CONCLUSION：The flap survival is directly infected by the venous pedicle style.A tributary out-flow vein can apparently enhance the viability of the venous flap.An appropriate pedicle style can keep a balance of perfusion-drainage in the venous flap so as to improve the viability of the venous flap.