游离皮瓣前负荷调节的实验研究

The influence of preload regulation on free flap： an experiment study

目的探讨在游离皮瓣静脉回流不足的情况下，通过利用“都江堰”水利工程原理及“流体力学”原理调节游离皮瓣的前负荷，观察其对皮瓣存活质量的影响。方法在20只新西兰大白兔的下腹部左右两侧按静脉回流不足的游离皮瓣模型设计两组游离皮瓣，均以腹壁下动脉为供血动脉及一条皮下静脉为回流静脉，A组（实验组）不结扎股动脉及其分支，保持股动脉及其分支的血流通畅；B组（对照组）在腹壁下动脉分叉处以远0．5cm处结扎股动脉，同时结扎邻近的股动脉分支。观察术后皮瓣的颜色、肿胀程度及皮瓣存活情况以及两组皮瓣的组织学改变，比较两组皮瓣的存活质量是否存在差异。结果A组皮瓣存活16例，坏死4例，成活率80％，B组皮瓣存活3例，坏死17例，成活率15％，两组皮瓣的成活率差异有统计学意义（P〈0．01）。结论在静脉回流不充分的情况下，可通过“都江堰”水利工程原理及流体力学原理对游离皮瓣前负荷进行分流减压，使皮瓣的灌注量与回流量达到平衡，提高游离皮瓣存活质量。

Objective To investigate the influence of adjusting the preload of the flap based on the ＂Du- Jiang-Yan＂ hydraulic engineering principles and fluid dynamics principles on flap survival and quality in flaps with venous congestions. Methods Two types of venous drainage deficient flaps were created on both sides of the lower abdomen in 20 New Zealand rabbits. The flaps had the inferior epigastric artery as the feeding artery and a subcutaneous vein as the drainage vessel. In group A （experiment group） the femoral artery and its braehes were kept patent. In group B （control group） the femoral artery was ligated 0.5 cm distal to its bifurcation from the inferior epigastric artery along with its proximal branches. The color of the flaps, the extent of swelling and flap survival were observed, as well as histological changes of the flaps. Flap survival and quality of the two groups were compared. Results In group A 16 flaps survived while 4 were lost to necrosis, with a survival rate of 80%. In group B 3 flaps survived while 17 were lost to necrosis, with a survival rate of 15%. The survival rates of the two groups were sioaificantly different （ P 〈 0.01 ）. Conclusion When there is venous drainage deficiency, adjusting preload of the flap using the ＂Du-Jiang-Yan＂ hydraulic engineering principles and the fluid dynamics orinciples to balance perfusion and drainage can increase flan survival and quality.