逆行与顺行岛状皮瓣血流及成活情况比较

Comparison of the blood stream and survival situation for reverse-flow versus smooth running island flaps

目的观察逆行与顺行岛状皮瓣血流动力学变化及成活情况。方法 2010年6—8月在中国医科大学口腔医学院将8只兔的1侧后肢随机设定为逆行皮瓣组,对侧即为顺行皮瓣组,进行同体对照,每组8个皮瓣。逆行皮瓣组血管蒂位于皮瓣的远端,制备成逆行岛状皮瓣;顺行皮瓣组血管蒂位于皮瓣的近端,制备成顺行岛状皮瓣。术中观察血液循环情况;术前及术后第1～9天,采用超声多普勒测量逆行和顺行岛状皮瓣血管蒂部的血流速度;术后第10天测定皮瓣成活情况;切取血管蒂做切片观察。结果逆、顺行皮瓣组术后血流速度总体上为下降后再回升,两组血流速度差异有统计学意义(P<0.05);两组隐动静脉血流方向相反,大隐静脉血流方向相同;逆行皮瓣组静脉窦扩张较顺行皮瓣组明显;逆行皮瓣组皮瓣成活面积百分比为(94.09±3.12)%,顺行皮瓣组为(96.5±4.73)%,二者差异无统计学意义(P>0.05);两组皮瓣蒂部均有散在分布的扩张小静脉,逆行皮瓣组较顺行皮瓣组多。结论逆行皮瓣组和顺行皮瓣组血流动力学方面差异具有统计学意义,但不影响皮瓣的成活。

Objective To investigate the efficacy of hemodynamics,and the survival situation of reverse-flow and smooth running island flaps. Methods From June to August,2010,in Stomatology Hospital of China Medical University,we employed 8 rabbits that were classified randomly as two paired-groups of 8 flaps.The vascular pedicle was maintained in distal end of limb as reverse-flow island flaps,then the vascular pedicle was retained in proximal end as smooth running island flaps in the other limb of the same rabbit.The information of blood circulation was measured in operation procedure after the tourniquet released. Survey the blood flow velocity of reverse-flow and smooth running island flaps using hyperacoustic Doppler in the location of vascular pedicle preoperatively and at 1～9 days postoperatively.Flap survival percentage was measured at 10 days postoperatively and the vascular pedicle was harvested and observed histologically. Results The trend of the velocity of blood flow exhibited totally to descend and ascend in the period of 1～9 days postoperatively in two groups of flaps,but there was significant difference in the statistics（P 0.05） .The direction of blood flow of saphenous artery and vein were distinct but the direction of blood flow of great saphenous vein was uniform. And flap survival percentage of reverse-flow group（94.09±3.12） % was lower than that of smooth running group（96.5±4.73） %（t = 1.24,P = 0.205） .The expansion of venous sinus in reverse-flow group was more obvious than that in smooth running group. Histological examination showed there were lots of dilated venules located in vascular pedicle in two groups.Especially,amount of dilated venules in reverse-flow group was more than that of smooth running group. Conclusion The hemodynamics of blood stream in reverse-flow group and smooth running group is significantly different,but it does not affect the survival percentage of reverse-flow island flaps and smooth running island flaps.