不同位置动脉超灌注与静脉超引流对大鼠三跨区皮瓣成活的影响

Effects of arterial supercharging and venous superdrainage at different sites on survival of three-territory flap in rats

目的通过建立大鼠背侧三跨区皮瓣模型,研究不同位置动脉超灌注与静脉超引流对大鼠三跨区皮瓣存活的影响。方法50只体质量300~400 g的SD雄性大鼠,均在背侧建立以旋髂深动静脉为主血管蒂的旋髂深血管-肋间后血管-胸背血管三血管体跨区皮瓣,随机分成5组,各10只。实验组A,保留肋间后动脉作为超灌注血管;实验组B,保留肋间后静脉作为超引流血管。实验组C,保留胸背动脉作为超灌注血管;实验组D,保留胸背静脉作为超引流血管。对照组E,除主血管蒂外不保留任何动静脉。术后7 d,对各组大鼠进行皮瓣存活面积测量、明胶氧化铅造影、chokeⅡ区取材CD31染色测微血管密度(MVD)。结果术后7d,A~E组皮瓣成活率分别为(95.9±2.2)%、(84.4±3.5)%、(98.3±0.8)%、(85.5±3.3)%、(70.0±3.9)%。同一位置的超引流及超灌注组(A与B、C与D)皮瓣成活率差异有统计学意义(P<0.05);不同位置的同一种技术(A与C、B与D)皮瓣存活率差异无统计学意义(P>0.05)。在组织学测微血管密度上同一位置的超引流及超灌注组(A与B、C与D)之间进行比较,实验组A与C的chokeⅡ区微血管密度均高于B、D组(均P<0.05);不同位置的同一种技术进行比较(A与C、B与D),chokeⅡ区的微血管密度差异均无统计学意义(均P>0.05)。结论不同位置进行静脉超引流及动脉超灌注对三跨区皮瓣成活的影响是不近相同的,不论是在动力学供区还是潜在供区动脉超灌注均较静脉超引流更能提高皮瓣成活率。

Objective To study the effects of arterial supercharging and venous superdrainage at different sites on the survival of three-territory flap in rats by establishing dorsal three-territory flap model.Methods Fifty SD male rats weighing 300~400 g were divided into five groups randomly,with ten rats in each group,and the dorsal threeterritory flap pedicled with deep circumflex iliac artery and vein was performed.In experimental group A,the posterior intercostal artery was retained as the supercharging vessel.In experimental group B,the posterior intercostal vein was retained as the superdrainage vessel.In experimental group C,the thoracodorsal artery was retained as the supercharging vessel.In experimental group D,the thoracodorsal vein was retained as the superdrainage vessel.Control group E did not retain any arteries and veins except the main pedicle.On the 7 th day after surgery,the flap survival area was measured,lead oxide gelatine angiography was performed,and microvessel density(MVD)was measured by CD31 staining in choke Ⅱ area.Results Seven days after operation,the flap survival rate from group A to E was(95.9±2.2)%,(84.4±3.5)%,(98.3±0.8)%,(85.5±3.3)%,(70.013.9)%respectively.There was statistical significance between the survival rate of superdrainage and supercharging groups(A vs B,C vs D)in the same sites(allP<0.05).There was no significant difference between the same technique at different positions(A vs C,B vs D)(all P>0.05).In terms of histological microvessel density,the microvessel density in choke Ⅱ area of experimental group A and C was higher than that of group B and D respectively(all P<0.05).There was no significant difference in microvessel density of choke Ⅱ area when comparing the same technique at different sites(A vs C,B vs D)(all P>0.05).Conclusions The effects of venous superdrainage and arterial supercharging on the survival of the three-territory flap were different in different sites.Arterial supercharging resulted in better survival rate of the flap than venous superdrainage in both dynamical and potential territory.