静脉动脉化法治疗皮肤大面积套脱伤的实验研究

An experimental study on the application of arterializalion of the vein in treating extensive degloving injury of the sldn

目的探讨以静脉动脉化法增加血液灌注对大面积套脱皮肤成活的影响。方法选取健康日本大耳白兔10只，将其双后肢随机分为实验侧和对照侧，制成3．3：1的皮肤逆行套脱伤的动物模型，实验侧将小腿近端胫后动静脉发出的皮肤营养血管切断，将动脉近端与静脉远端吻合，并吻合大隐静脉和小隐静脉；而对照侧只吻合大隐静脉和小隐静脉。结果对照侧套脱皮肤平均成活50．5％，实验侧套脱皮肤平均成活60．2％，两者差异有统计学意义（P〈0．05）；对照侧套脱皮肤平均挛缩31．9％，实验侧套脱皮肤平均挛缩26．9％，两者差异无统计学意义（P〉0．05）。血气分析显示，对照侧腹股沟平面的静脉血Pa02为41．32mmHg（1mmHg=0．133kPa），实验侧腹股沟平面的静脉血Pa02为60．35mmHg，两者差异有统计学意义（P〈0．05）。结论静脉动脉化法可增加套脱皮肤的血液灌注，有利于套脱皮肤的成活；但其非生理性血液循环方式对套脱皮肤的成活又有一定的负面影响。

Objective To investigate the influence on the survival of extensively degloved skin by increasing peffusion via venous arterialization. Methods Extensive degloving injury model was created by making 3.3：! distal-based skin avulsion in 20 rear legs of 10 healthy Japanese white rabbits. The legs of each rabbit were randomly assigned as the experimental side and control side. On the experimental side, nutrition vessels from the posterior tibial artery and vein were severed and the proximal artery was anastomosed to the distal vein. Both the greater and lesser saphenous veins were anastomosed. On the control side only the greater and lesser saphenous veins were anastomosed. Results On the experimental side 60.2% of the degloved skin survived, while 50.5% of the degloved skin survived on the control side. The difference was statistically significant （ P 〈0.05）. Skin contraction was 26.9% on the experimental side and 31.9% on the control side, the difference not being significant （P 〉 0.05）. Blood gas analysis of groin veins was 41.32 mmI-Ig on the control side and 60.35 mmHg on the experimental side for venous blood PaO2. The difference was statistically significant （ P 〈 0.05）. Conclusion Arterialization of the vein can augment blood perfusion of degloved skin and increase skin survival. However, as a non-physiological blood circulation, it also promotes blood congestion, tissue swelling and fibrosis of the degloved skin.