小型猪静脉增流DIEP皮瓣的血流动力学研究

Hemodynamic Studies of The Venous Augmented DIEP Flap in Pig

目的研究静脉增流对小型猪腹壁下动脉穿支(DIEP)皮瓣成活面积的影响及其血流动力学特点。方法选取24头小型猪,在其腹部形成模拟增流DIEP皮瓣和传统DIEP皮瓣,并进行相应指标测量。包括皮瓣的血流灌注,静脉血管的压力,以及静脉血气分析。血流动力学测量后,所有腹部皮瓣原位缝合,随机选取12只形成静脉增流的DIEP皮瓣(实验组),其余12只为传统的DIEP皮瓣(对照组)。术后7 d进行活检,测量皮瓣的成活面积。结果在静脉增流模式下,各血流动力学指标均较无增流情况下明显改善。对照组皮瓣成活率为(82.1±7.6)%,实验组为(99.4士1.2)%,差异显著。结论静脉增流技术可显著改善DIEP皮瓣灌注并增加皮瓣成活面积。就大面积皮瓣而言,静脉增流技术是改善静脉淤血和增大皮瓣成活面积的可靠方式。

Objective To evaluate the efficacy of venous augmentation of DIEP flap in pig and to clarify the hemodynamics. Methods Twenty four female Yorkshire micro-pigs were included. All of the pigs were performed DIEP flap surgery to form DIEP flap and venous augmented DIEP flap, then several hemodynamic indexes between the two different flap types were evaluated and compared, including flap perfusion, venous pressure and venous blood gas analysis. After the analysis of the dynamics, all of the flaps were sutured up, while 12 of the flaps formed venous augmented DIEP flap （experimental group） and the rest 12 pigs formed classic DIEP flap （control group）. The animals were sacrificed at the 7th postoperative day, and the final partial necrosis rate and the survival rate were compared between the two groups. Results Compared to the condition in none venous augmentation, all the dynamic indexes were improved dramatically after the application of venous augmentation. The flap survival rate was （99.4±1.2）% in the experimental group, and （82.1±7.6）% in the control group. There was significant difference between the two groups. Conclusion The venous augmentation technique is effective in promoting the blood perfusion and elevating the viability of DIEP flap. Venous augmentation is a reliable technique to improve flap venous congestion and viability, especially for those large flaps.