B型肉毒素干预choke Ⅱ区对大鼠跨区皮瓣的影响

Effect of Intra-operative Injection of BTX B in Choke Zone Ⅱ on Extended Perforator Flap Survival in a Rodent Model

目的研究B型肉毒毒素(BTX B)术中干预大鼠背部跨区穿支皮瓣choke Ⅱ区对皮瓣成活的影响。方法在大鼠背部建立三血管体穿支皮瓣模型,50只SD大鼠采用数字表法随机分为实验组(B型肉毒素组)和对照组(生理盐水组),术后即刻,对实验组皮瓣choke Ⅱ区皮下间隔0.2mm均匀注射100U,总计1500U(约0.3ml) BTX B,对照组采用相同剂量生理盐水均匀注射choke Ⅱ区。术后7天分别检测两组皮瓣的成活率;用明胶-氧化铅灌注进行皮瓣造影;取蒂部组织做HE测蒂部穿支动脉血管管径变化;取choke Ⅱ区域组织做HE测微血管数量;取choke Ⅱ区域组织做RT-PCR测VEGF、HIF-1α的表达情况。结果术后7天,实验组皮瓣的成活面积(90±2.9)%显著高于对照组(75±3.2)%,差异有统计学意义(P<0.01);明胶-氧化铅灌注造影显示实验组choke区真性吻合数较对照组明显增多。实验组choke Ⅱ区VEGF、HIF-1α基因表达均明显高于对照组(P<0.01)。实验组蒂部穿支动脉管径大于对照组(P<0.01),新生血管计数高于对照组(P<0.05)。结论 B型肉毒毒素可以促进皮瓣choke血管扩张及血管新生改善皮瓣血供,从而提高了大鼠背部跨区穿支皮瓣的成活。

Objective To investigate the effect of Intra-operative Injection of Botulinum toxin B(BTX B)in Choke zoneⅡon extended perforator flap survival in a rodent model.Methods A three-territory flap was elevated based on the cutaneous perforator of deep circumflex iliac vessel on a rat.Fifty SD rats were randomly divided into control group and experimental group.After elevating the flap,BTX B was injected in subcutaneous,every 2mm apart,of chokeⅡzone in the experimental group,while the same volume of saline was administered to the control group.After 7 days,flap survival area and microangiography were appraised.Tissue samples were taken from pedicle zone and choke zoneⅡfor histologic study,Hypoxia-Inducible Factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)expression detection.Results 7 days after operation,viability of the skin flaps of experimental group were significantly improved.The number of true anastomosis in choke zones of experimental group was significantly increased.HIF-1αand VEGF expression in choke zoneⅡof the experimental group were significantly higher than those in the control group.Neovascularization in choke zoneⅡof experimental group were enhanced markedly compared with control group.Perforating artery diameter in pedicle zone of experimental group was dilated obviously compared with control group.Conclusion We suggested that Intra-operative injection Choke zoneⅡwith BTX B improved skin flap viability and increased angiogenesis and choke vessles vasodilation in rat models.