岛状筋膜瓣预构扩张皮瓣的实验研究

Experimental study on prefabricated induced expanded flap using island fascia vascular flap

目的 在动物模型上探索岛状筋膜瓣诱导预制扩张皮瓣的存活和血供建立时限 ,为临床应用提供理论依据。方法 在大白鼠的侧胸腹形成以侧胸血管为蒂的岛状筋膜瓣 (1.5cm× 2 .0cm) ,经皮下转移至背部 ,其下埋置扩张器 ,扩张完毕后 ,形成以筋膜瓣血管蒂为载体的预构扩张皮瓣 ,观察皮瓣的成活 ,并行微血管照影 ,了解且扩展可促进微血管的再生微血管构建情况。结果 岛状筋膜瓣的血管与皮肤血管网在 3周后即建立了良好的吻合 ,预构皮瓣建立了丰富的血供 ,且扩展可促进微血管的再生 ,预构皮瓣的长宽可比筋膜瓣大 2 .5～ 4.0倍。结论 皮肤扩张的同时应用岛状筋膜瓣预构的轴型皮瓣能建立起丰富的血管网 ,以筋膜瓣血管为蒂移植安全 ,较传统扩张或随意皮瓣应用更灵活 ,可将岛状或游离皮瓣作远位移植 。

Objective Surviing and blood supply of prefabricated induced expanded flap(PIE flap) by island fascia vascular flap were investigated in rat model. Methods Island facial flap was elevated on lateral chest wall in rat and was transferred to its back , an expander was buried under it. After the expander was fully expanded, an island skin flap was elevated based on the fascia vascular pedicle. Survive of the flap was observed, and microangiography was utilized to examine the building of blood vessel network in the flap.Results The micro vessels of the fascia flap were anastomosed very well with vascular network of the overlying skin. Furthermore, the angiogenesis occuring in the capsule of the expanded tissue enhanced neovascular collaterals between the fascia carrier and the skin. The length or width of the PIE flap could be 2.5～4.0 times larger than the fascia flap. Conclusion Compared with the conventional expansion and adjacent flap transfers, PIE flap as an island or free flap nourished by induced vascular pedicle allows the transfer of expanded skin to more distant sites, and the flap is thinner.