远端静脉对大鼠背部四血管体跨区穿支皮瓣成活的影响

Effect of distal veins on the survival of dorsal four-territory perforator flaps in rats

目的探讨远端静脉对SD大鼠背部四血管体跨区穿支皮瓣成活的影响。方法32只SD大鼠采用随机数字表法分为对照组和实验组,每组16只。于大鼠背部切取包含左、右两侧髂腰血管体和左、右两侧肋间后血管体的跨区穿支皮瓣,面积为6 cm×7 cm,对照组保留右侧髂腰动、静脉,实验组保留右侧髂腰动脉和右侧肋间后静脉,2组均将右侧髂腰血管体和右侧肋间后血管体之间切开,最后将皮瓣进行原位缝合。术后6 h及1、3、5、7 d,测量两侧髂腰血管体区和左侧肋间后血管体区的血流灌注量。术后7 d,统计皮瓣成活面积百分比;动脉造影观察皮瓣区动脉扩张情况;取choke2区皮肤组织行HE染色后测量choke动脉内径;采用蛋白质印迹法检测内皮型一氧化氮合酶(eNOS)蛋白相对表达量。采用SPSS 28.0软件进行统计学分析,计量资料以±s表示,2组间比较采用独立样本t检验,P<0.05为差异有统计学意义。结果(1)术后6 h及1、3、5、7 d,实验组左侧和右侧髂腰血管体区及左侧肋间后血管体区的血流灌注量均大于对照组(P均<0.01)。(2)术后7 d,实验组皮瓣区动脉扩张比对照组明显;实验组皮瓣成活面积百分比为(87.6±3.2)%,明显大于对照组的(65.3±3.0)%(P<0.01);实验组choke动脉内径为(49.3±3.1)μm,大于对照组的(35.1±2.3)μm(P<0.01);实验组eNOS蛋白相对表达量为0.87±0.07,高于对照组的0.50±0.05(P<0.01)。结论SD大鼠背部四血管体跨区穿支皮瓣远端静脉(右侧肋间后静脉)通过对蒂部动脉供血进行直接引导,促进eNOS的表达,扩张皮瓣各区动脉,增加皮瓣远端动脉供血,从而提高皮瓣的成活面积。

Objective To explore the effect of distal veins on the survival of a dorsal four-territory perforator flap in rats.Methods A total of 32 SD rats were randomly divided into the control group and the experimental group,with 16 rats in each group.The multi-territory perforator flap including the bilateral iliolumbar and bilateral posterior intercostal angiosomes was cut from the back of each rat,with the size of 6 cm×7 cm.The right iliolumbar artery and vein were preserved in the control group,while the right iliolumbar artery and the right posterior intercostal vein were preserved in the experimental group.In both groups,incisions were made between the right iliolumbar angiosome and the right posterior intercostal angiosome.Finally,the flap was sutured back to their orthotopic site.At 6 hours and 1,3,5,7 days after surgery,the blood perfusion at the bilateral iliolumbar and the left posterior intercostal vascular territories were measured.On the seventh day after surgery,the percentage of the survived area of the flaps were evaluated,arteriography was performed to observe the dilation of arteries within the flap,the intraluminal diameter of the choke artery in the choke 2 area was measured using hematoxylin and eosin staining,and the relative expression of endothelial nitric oxide synthase(eNOS)was detected by Western blotting.SPSS 28.0 was used for statistical analysis,and measurement data were presented as Mean±SD.Independent sample t-test was used to compare data across two groups.P<0.05 was considered statistically significant.Results(1)At 6 hours and 1,3,5,7 days after surgery,the experimental group displayed higher blood perfusion than the control group at the bilateral iliolumbar and the left posterior intercostal vascular territories(all P<0.01).(2)On the 7th day after surgery,the artery dilation of the experimental group was more obvious than that of the control group;the percentage of the survived flap area in the experimental group was higher than that in the control group[(87.6±3.2)%vs.(65.3±3.0)%,P<0.01];the intraluminal diameter of the choke artery was greater in the experimental group than that in the control group[(49.3±3.1)μm vs.(35.1±2.3)μm,P<0.01];and the relative expression of eNOS in the experimental group was higher than that in the control group(0.87±0.07 vs.0.50±0.05,P<0.01).Conclusion The distal vein(right posterior intercostal vein)of dorsal four-territory perforator flap of SD rats directly guided the pedicle artery blood supply to promote the expression of eNOS,dilated the arteries in each zone of the flap,increased the blood supply to the distal artery of the flap,and ultimately enhanced the flap survival area.