关于跨区穿支皮瓣远端血流动力学的再探究

Further study of hemodynamics in the distal end of multi-territory perforator flap

目的总结和探讨影响跨区穿支皮瓣远端血流动力学的关键因素,为该领域后续研究和临床应用提供理论依据。方法广泛查阅近年来国内外关于跨区穿支皮瓣相关文献,对与其相关的穿支体、choke区、动脉超灌注、静脉超引流等概念和研究进行梳理和归纳总结。结果跨区穿支皮瓣由多穿支体构成,各穿支体间的choke区存在不同类型血管吻合,它们对于皮瓣血流动力学会产生重要影响。为了保证跨区穿支皮瓣成活,目前临床主要采用动脉超灌注和/或静脉超引流处理皮瓣,但是对于两种技术的选择尚未达成共识,相关研究的结果存在明显差异,分析与实验模型皮瓣内部血管分布、穿支体数量和吻合类型不同有关。结论穿支血管位置、管径、轴向性以及穿支体数量及之间的choke区吻合类型,都是影响跨区穿支皮瓣血液动力学的关键因素,需要在术前设计和手术操作中予以重视。

Objective To summarize and discuss the key factors affecting the hemodynamics in the distal end of the multi-territory perforator flap,so as to provide a theoretical basis for the follow-up research and clinical application in this field.Methods The related recent literature about multi-territory perforator flaps was extensively reviewed,and the concepts and researches of perforasome,choke vessel zone,arterial super-charge,and venous super-drainage were summarized.Results The multi-territory perforator flap is composed of multiple perforasomes,and there are different types of vascular anastomosis in the choke vessel zones,which have important impacts on the hemodynamics of the flap.In order to ensure the survival of the multi-territory perforator flap,arterial super-charge and venous super-drainage are mainly used in clinical practice.However,no consensus has been reached on the choice of the two techniques.The different distribution of blood vessels in the flap,the number of perforasomes,and the type of vascular anastomosis may be the main reasons for the different results.Conclusion The location,diameter,and axial characteristics of perforators,the number of perforasomes,and the type of vascular anastomosis are the key factors affecting the hemodynamics of the multi-territory perforator flaps,which should be paid attention to in preoperative design and surgical procedure.