负压封闭引流技术对淤血皮瓣微血管及微血栓的影响

Effect of vacuum sealing drainage on small vessels and microthrombus of congested flap

目的探讨应用负压封闭引流技术（vacuum sealing drainage，VSD）埘淤血皮瓣微血管及微血栓的影响。方法SD大鼠56只，制作淤血皮瓣模型：每只大鼠背部两侧各设计1块皮瓣，一侧（对照侧）为埘照瓣，另一侧（实验侧）为实验瓣，实验瓣上安装VSD，随机分为：术后1h组、4h组、1d组、2d组、3d组、4d组、7d组，每个组内又分对照瓣和实验瓣。在术后不同时间点，观察皮瓣成活状态及面积，并对皮瓣的血管内皮细胞、微血栓、低氧诱导因子-1α（HIF-1α）进行检测。结果（1）同一时间点，文验瓣血管内皮细胞损伤较对照瓣轻，微血栓壁较对照瓣少。（2）从不同时间点HIF1α的表达来看．实验瓣前3d上升趋势不明显，第4天开始明显上升．而对照瓣随着时间推移不断增加，第6天达到最高值。（3）实验瓣淤血轻，成活面积大，第3天达到最大值。结论早期应用VSD可主动吸出皮瓣内淤滞的血液，改善皮瓣组织细胞缺血、缺氧的状态，从而减少内皮细胞损伤及微血栓的形成，进而终止微循环恶化趋势，促进淤血皮瓣成活。

Objective To discuss the effect of early application of vacuum sealing drainage （VSD） on the small vessels and microthrombus of congested flap. Methods 56 SD rats were random ly divided into 7 groups after operation： one-hour group, four-hour group, one-day group, two-day group, three day group, four-day group and seven-day group. A flap was designed and put on either side of a rat＇s back. The flaps were randomly arranged into control group and the flaps on the other side served as the experiment group. The equipment of VSD was fixed to each experiment flap. We observed and measured the flap, survival area, the expression of HIF-lα and vascular endothelial cell and microthrombus on the flap at different time. Results Firstly, the damage of vascular endothelial cell and microthrombus in the experiment flaps was less than the control group of flaps at the same time, so as the expression of HIF-lα. Secondly, the trend of expression of HIF-lα did not rise obvi-ously in first 3 days and rose obviously from the 4th day in the experiment flaps; but in the control flaps, when timeqapse, the expression of HIF-la increased, reached the plateau level at 6th day. Thirdly, the congestion of experimental flap was mitigated as compared with those under control, and the survival area was bigger, and it reached the top on the third day. Conclusions The application of VSD early to flap can aspirate detained blood initiatively, reduce the isehemic and hypoxic status of the tissue of flaps, and so it can lessen the damage of vascular endothelial cell and the formation of micro thrombus of flap, beneficial for the survival of flap.