腓肠神经伴行血管逆行筋膜皮瓣阻隔延迟的实验研究

Experimental study of obstructing delayed effect of revers sural neurocutaneous vascular flaps

目的 探讨兔腓肠神经伴行血管逆行阻隔延迟皮瓣转位的最佳手术时间,为该皮瓣的临床应用提供实验依据.方法 按随机数字表格法将20只新西兰大白兔分为实验组和对照组,每组10只,制作双后肢腓肠神经伴行血管逆行皮瓣,每组20个皮瓣.实验组采用阻隔延迟方法预制皮瓣,对照组采用非阻隔延迟方法预制皮瓣.术后观察皮瓣血运情况,并分别在术后1 ～12d用彩色多普勒超声观察该皮瓣蒂部血管内径、血流峰值及穿支血管数量.对实验数据进行两个独立样本t检验及重复测量方差分析.结果 大体观察：两组术后皮瓣全部成活.实验组皮瓣于术后（6.1±1.5）d肿胀消退、出现皮纹,对照组于术后（8.2±1.9）d肿胀消肖退、出现皮纹,实验组肿胀消退时间短于对照组,差异有显著统计学意义（P＜0.01）.实验组在皮瓣形成术后1～12 d随天数的增加蒂部血管内径、血流峰值及穿支血管数量均大于对照组,两组比较差异具有统计学意义（P均小于0.05）.在同一时间点上实验组皮瓣蒂部血管内径、血流峰值及穿支血管数量均高于对照组.实验组与对照组皮瓣蒂部的血管内径、血流峰值及穿支血管数量在术后1～2d比较差异无统计学意义（P均大于0.05）.实验组皮瓣蒂部的血管内径、血流峰值及穿支血管数量从术后3d开始到术后8d随时间一直上升（P均小于0.05）,术后8d到术后10 d后趋于稳定（P均大于0.05）;对照组皮瓣蒂部的血管内径、血流峰值及穿支血管数量从术后3d到术后10 d随时间一直上升（P均小于0.05）,10 d后趋于稳定（P均小于0.05）.结论 兔后肢腓肠神经营养血管逆行阻隔延迟皮瓣较非阻隔延迟皮瓣血运明显增强,可将皮瓣转位手术预制时间提前,阻隔延迟皮瓣的最佳手术时间为术后8d,非阻隔延迟皮瓣为术后10d.

Objective Through establishing the sural neurocutaneous vascular flaps model with New Zealand white rabbits, to explore the rabbit reversed sural nerve with vessel barrier delayed the best operation time of prefabricated skin flap and provide experimental basis for the clinical application of skin flap. Methods Twenty New Zealand rabbits were divided into the experimental group and the control group by random number table with each group of 10 rabbits. The experimental group prefabricated flap using blocking delay method, while the control group using non-blocking delay method. Postoperative skin flap vascularized was observated, and the first day to the 12th day after the surgery the skin flap pedicled with vascular blood flow peak and the number of Perforator vessel diameter were observated with color Doppler ultrasonic. Repeated measures analysis of variance and t test for two independent samples were used to analyse experimental data. Results General observation： there was no differences between the two goups of flaps after operation. The experimental group swelling receded and had skin wrinkles in （6.1±1.5 ） after operation, the control group swelling receded and had skin wrinkles in （8.2±1.9） d after operation, the experimental group swelling receded faster than the control group（ P 〈 0.01 ）. The experimental group flaps formed in the skin flap after surgery the first day to the 12th day of the pedicle artery diameter, flow peaks and Perforator vessels has a statistically significant number compared with the control group （P less than 0.05）. the experimental group flaps pedicled with vascular blood flow peak and the number of Perforator vessel diameter are higher than those of control group at the same time point. The experimental group and the control group in flap formation of 1-2 days after no apparent change （P greater than 0. 05 ）. The experimental group from 3th day onwards until the 8th day after the operation has been on the rise over time （ P less than 0.05 ）, and stabilized after 8 days （ P greater than 0.05 ） ; the control group from a cut began 3th to 10th day has been on the rise over time （P less than 0.05 ）, and stabilized after 10 days （P greater than 0.05）. Conclusion Rabbit hind limb reverse blocking delay flap pedicled with nutrient vessels of sural nerve are stronger than non-blocking delay flap blood circulation, the flap surgery in advance, the best operation time of blocking delay flap is the 8th day after the operation, while the best operation the of non- blocking delay flap is the 10th day.