低氧模拟剂预处理提高预构皮瓣成活率的实验研究

Experimental Study on Improving Survival Rate of Prefabricated Skin Flap with Hypoxic Preconditioning Agent

目的探索应用低氧模拟剂预处理以促进预构皮瓣的再血管化,提高皮瓣成活率及应用的安全性。方法利用Wistar大鼠制作腹部预构皮瓣模型。一期先将股血管束转位至腹壁皮下形成腹壁预构皮瓣,经4周的再血管化;二期时掀起以股血管束为蒂的岛状腹部皮瓣。实验分4组:对照组、去铁胺腹腔注射组、去铁胺皮下注射组及手术延迟组。对比评价每组二期术后预构皮瓣的成活率及微血管密度,同时在体外实验中观察低氧模拟剂去铁胺(DFO)及二甲氧乙二酰甘氨酸(DMOG)对大鼠皮肤成纤维细胞的影响。结果不论皮下局部用药还是腹腔全身用药,去铁胺治疗组的皮瓣存活率及微血管密度皆高于对照组(P<0.001),与延迟组的治疗效果相当。大鼠皮肤成纤维细胞培养液中加入DFO及DMOG后,血管化相关因子的表达水平显著升高。结论在预构皮瓣一期手术时使用低氧模拟剂去铁胺,能显著提高预构皮瓣的血管化并增强皮瓣活力。

Objective To explore a practical method using hypoxic preconditioning agent to increase neovascularization of the prefabricated flap,so as to increase its survival rate and application safety.Methods An abdominal prefabricated flap model was created in rats via a 2-stage operation.The rats were allocated into 4 groups according to different treatment.Group 1:control group;Group 2 and 3 received desferrioxamine(DFO)treatments after the first stage operation by intraperitoneal and subcutaneous injection respectively.Group 4 received a delay procedure 1 week before the second stage operation.Flap survival rates and capillary densities were evaluated in the 4 groups.The influence of DFO and Dimethyloxallyl Glycine(DMOG)on the dermal fibroblasts was also studied in vitro.Results DFO treatment as well as surgical delay greatly increased flap survival rate and capillary density compared to the blank control.In vitro,DFO and DMOG treatment up-regulated the expression levels of several angiogenic factors in the dermal fibroblasts.Conclusion The application of DFO after the first stage operation of flap prefabrication can greatly promote the neovascularization of prefabricated flaps.