调节动脉化静脉皮瓣前负荷的实验研究

An experimental study on regulating the preload of arterialized venous skin flap

目的 研究调节动脉化静脉皮瓣的前负荷,减少静脉皮瓣术后的组织肿胀程度,对皮瓣存活质量的影响.方法 选取新西兰大白兔10只,在下腹壁两侧设计静脉皮瓣共20例,利用股动脉分支（腹壁下动脉）与一条静脉皮瓣皮下静脉吻合形成动脉化静脉皮瓣.左侧为实验组10例,不结扎股动脉远端,形成动脉压力和血流分流调节模式;右侧为对照组10例,结扎腹壁下动脉分支以远股动脉主干,形成股动脉-腹壁下动脉直接供血模式.在对照组结扎股动脉前后分别测定腹壁下动脉内血压的变化.于术后3d在皮瓣边缘取材,对静脉皮瓣组织学进行观察.结果 实验组静脉皮瓣存活8例,部分存活1例,坏死1例;对照组静脉皮瓣存活5例,部分存活4例,坏死1例,两组差异有统计学意义（P＜0.05）.实验组静脉皮瓣存活质量优于对照组.压力测定结果显示,不结扎股动脉与结扎股动脉两种情况下,腹壁下动脉收缩压平均降低10％.皮瓣组织学观察,实验组结果优于对照组.结论 通过术式改良调节动脉化静脉皮瓣的前负荷,改善了皮瓣内血液的灌流平衡,减少了静脉皮瓣术后的组织肿胀,静脉皮瓣存活质量得到明显改善.

Objective To investigate the impact of regulating the preload of arterialized venous flap and reducing postoperative tissue swelling on flap survival and quality.Methods Ten New Zealand white rabbits were used to create 20 venous flaps on both sides of the abdominal wall.A branch of the femoral artery （inferior epigastric artery） was anastomosed with a subcutaneous vein in the venous flap to arterialize the venous flap.The 10 flaps on the left side were designated as venous flaps of the experimental group in which the distal end of the femoral artery was not ligated,forming a mode of regulated pressure in the artery and blood flow bypass.The 10 flaps on the right side were designated as venous flaps of the control group in which the main femoral artery distal to the branch of inferior epigastric artery was ligated,forming a femoral artery-inferior epigastric artery direct blood supply mode.Before and after ligation of the femoral artery in the control group,the changes of pressures in the inferior epigastric artery were determined.Tissue samples were collected from the edge of the flaps 3 days after the operation for histological observation.Results In the experimental group,8 venous flaps survived completely,while 1 partially survived and 1 necrotized.In the control group,5 venous flaps survived,while 4 partially survived and 1 necrotized.There was statistically significant difference in flap survival between the two groups （P ＜ 0.05）.The survival quality of venous flaps in the experimental group was better than that in the control group.Measurement of inferior epigastric artery pressure showed that the systolic pressure without ligation of the femoral artery was 10％ lower than that with ligation of the femoral artery.Histology of flaps revealed better results in the experimental group.Conclusion The modification of arterialized venous flap regulates the perfusion pressure （preload） and improves the balance of blood perfusion in the flap.The occurrence of postoperative tissue swelling is reduced.The survival quality of the venous flap is greatly improved.