皮瓣延迟术对大鼠三血管体穿支皮瓣成活的影响及其机制
피판연지술대대서삼혈관체천지피판성활적영향급기궤제
Effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat and its mechanism
  • 万方数据
    中华烧伤杂志 중화소상잡지
    16
    2014年 4期 337-343 ,共7页

    李俊杰%高自勉%高伟阳%李浙峰

    리준걸%고자면%고위양%리절봉

    创伤和损伤%外科皮瓣%闭塞血管%血管体%延迟术 創傷和損傷%外科皮瓣%閉塞血管%血管體%延遲術
    창상화손상%외과피판%폐새혈관%혈관체%연지술
    Wounds and injuries%Surgical flaps%Choke vessel%Angiosome%Surgical delay
    目的 观察皮瓣延迟术对大鼠三血管体穿支皮瓣成活的影响并探讨其可能机制.方法 本实验采用大鼠背部右侧以旋髂深动脉为蒂的三血管体穿支皮瓣模型,将3个血管体之间的2个交界区域由皮瓣蒂部开始以远依次命名为闭塞区域1、闭塞区域2.按随机数字表法将110只SD大鼠分为常规皮瓣组40只、单纯延迟组30只、延迟皮瓣组40只.(1)于常规皮瓣组中,按随机数字表法选取30只大鼠直接行皮瓣手术,术后0(即刻)、1、2、3、7d分别处死6只,取2个闭塞区域全层皮肤组织行HE染色检测血管密度及外径.剩余10只大鼠颈外静脉置管后行皮瓣手术,从术后0d(5只)或术后1d(5只)开始每隔2d注射1.5 mL荧光素钠(100 g/L)观察皮瓣血运变化,每只注射4次;术后7d,计算10只大鼠皮瓣成活率,采用改良氧化铅-明胶灌注法行血管造影观察皮瓣内血管形态与分布.(2)单纯延迟组大鼠仅通过局部皮肤小切口手术结扎右侧胸背动脉,术后0(即刻)、1、2、3、7 d分别处死6只大鼠同常规皮瓣组部位取皮肤标本测量血管密度及外径.(3)延迟皮瓣组大鼠按单纯延迟组术式行延迟手术,术后7d按与常规皮瓣组相同的方法选取、分配及处理本组所有大鼠并检测相应指标.对数据行成组样本t检验、析因设计方差分析、SNK检验. 结果 (1)3组间比较,术后7d闭塞区域1、闭塞区域2血管密度差异均明显(F值分别为2.69、2.76,P值均小于0.05).延迟皮瓣组大鼠术后7d闭塞区域1、闭塞区域2血管密度分别为(29±7)、(31±8)个/mm2,显著高于常规皮瓣组的(23±5)、(23 ±3)个/mm2(q值分别为5.67、6.01,P值均小于0.05),且显著高于组内术后0d水平(q值分别为6.42、7.14,P值均小于0.05).术后3、7d,常规皮瓣组、延迟皮瓣组大鼠闭塞区域1血管外径显著高于单纯延迟组(q值为8.15～11.13,P值均小于0.05);延迟皮瓣组术后0、1、2、3、7 d[(65±8)、(63±13)、(69 ±9)、(67±8)、(64±13) μm]及单纯延迟组术后3、7d闭塞区域2Ⅱ血管外径显著高于常规皮瓣组相应时相点血管外径水平[术后0、1、2、3、7d分别为(46±10)、(40 ±9)、(43±13)、(46±12)、(47±11)μm],q值为7.29～10.79,P值均小于0.05.常规皮瓣组、单纯延迟组大鼠术后3、7d以及延迟皮瓣组大鼠术后0、1、2d组内闭塞区域1与闭塞区域2间血管外径比较,差别明显(q值为5.32～9.56,P值均小于0.05).术后3、7d,常规皮瓣组及延迟皮瓣组大鼠闭塞区域1、单纯延迟组大鼠闭塞区域2血管外径显著高于组内术后0d(q值为6.12～8.13,P值均小于0.05).(2)术后7d内,常规皮瓣组、延迟皮瓣组大鼠皮瓣内来自蒂部的血液都顺利通过闭塞区域1覆盖血流动力学供区.术后0d,2组大鼠皮瓣内的血液越过闭塞区域1后均发生持续约3 min的血流阻塞现象,常规皮瓣组出现在闭塞区域2附近,延迟皮瓣组出现在闭塞区域2远端约1 cm处.(3)术后7d,延迟皮瓣组大鼠皮瓣成活率为(95±12)％,显著高于常规皮瓣组的(80±9)％(t=2.91,P ＜0.01),皮瓣部分坏死仅出现在潜在供区.(4)术后7d,与未行手术的左侧皮肤血管相比,常规皮瓣组大鼠皮瓣内闭塞区域1的血管扩张明显,相邻血管树间界限模糊,而闭塞区域2的血管变化轻微;延迟皮瓣组大鼠皮瓣内2个闭塞区域的血管均明显扩张. 结论 本实验的延迟方法可促进大鼠三血管体穿支皮瓣潜在供区的成活,其主要是通过皮瓣术前扩张闭塞区域2的闭塞血管实现的.
    목적 관찰피판연지술대대서삼혈관체천지피판성활적영향병탐토기가능궤제.방법 본실험채용대서배부우측이선가심동맥위체적삼혈관체천지피판모형,장3개혈관체지간적2개교계구역유피판체부개시이원의차명명위폐새구역1、폐새구역2.안수궤수자표법장110지SD대서분위상규피판조40지、단순연지조30지、연지피판조40지.(1)우상규피판조중,안수궤수자표법선취30지대서직접행피판수술,술후0(즉각)、1、2、3、7d분별처사6지,취2개폐새구역전층피부조직행HE염색검측혈관밀도급외경.잉여10지대서경외정맥치관후행피판수술,종술후0d(5지)혹술후1d(5지)개시매격2d주사1.5 mL형광소납(100 g/L)관찰피판혈운변화,매지주사4차;술후7d,계산10지대서피판성활솔,채용개량양화연-명효관주법행혈관조영관찰피판내혈관형태여분포.(2)단순연지조대서부통과국부피부소절구수술결찰우측흉배동맥,술후0(즉각)、1、2、3、7 d분별처사6지대서동상규피판조부위취피부표본측량혈관밀도급외경.(3)연지피판조대서안단순연지조술식행연지수술,술후7d안여상규피판조상동적방법선취、분배급처리본조소유대서병검측상응지표.대수거행성조양본t검험、석인설계방차분석、SNK검험. 결과 (1)3조간비교,술후7d폐새구역1、폐새구역2혈관밀도차이균명현(F치분별위2.69、2.76,P치균소우0.05).연지피판조대서술후7d폐새구역1、폐새구역2혈관밀도분별위(29±7)、(31±8)개/mm2,현저고우상규피판조적(23±5)、(23 ±3)개/mm2(q치분별위5.67、6.01,P치균소우0.05),차현저고우조내술후0d수평(q치분별위6.42、7.14,P치균소우0.05).술후3、7d,상규피판조、연지피판조대서폐새구역1혈관외경현저고우단순연지조(q치위8.15～11.13,P치균소우0.05);연지피판조술후0、1、2、3、7 d[(65±8)、(63±13)、(69 ±9)、(67±8)、(64±13) μm]급단순연지조술후3、7d폐새구역2Ⅱ혈관외경현저고우상규피판조상응시상점혈관외경수평[술후0、1、2、3、7d분별위(46±10)、(40 ±9)、(43±13)、(46±12)、(47±11)μm],q치위7.29～10.79,P치균소우0.05.상규피판조、단순연지조대서술후3、7d이급연지피판조대서술후0、1、2d조내폐새구역1여폐새구역2간혈관외경비교,차별명현(q치위5.32～9.56,P치균소우0.05).술후3、7d,상규피판조급연지피판조대서폐새구역1、단순연지조대서폐새구역2혈관외경현저고우조내술후0d(q치위6.12～8.13,P치균소우0.05).(2)술후7d내,상규피판조、연지피판조대서피판내래자체부적혈액도순리통과폐새구역1복개혈류동역학공구.술후0d,2조대서피판내적혈액월과폐새구역1후균발생지속약3 min적혈류조새현상,상규피판조출현재폐새구역2부근,연지피판조출현재폐새구역2원단약1 cm처.(3)술후7d,연지피판조대서피판성활솔위(95±12)％,현저고우상규피판조적(80±9)％(t=2.91,P ＜0.01),피판부분배사부출현재잠재공구.(4)술후7d,여미행수술적좌측피부혈관상비,상규피판조대서피판내폐새구역1적혈관확장명현,상린혈관수간계한모호,이폐새구역2적혈관변화경미;연지피판조대서피판내2개폐새구역적혈관균명현확장. 결론 본실험적연지방법가촉진대서삼혈관체천지피판잠재공구적성활,기주요시통과피판술전확장폐새구역2적폐새혈관실현적.
    Objective To observe the effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat,and to explore its possible mechanism.Methods The flap model was a perforator flap with three angiosomes which located on the right dorsal side of a rat based on thc right deep circumflex iliac vessel.The two connection areas between the three angiosomes were successively named choke zone (CZ) 1 and CZ 2 beginning from the pedicle to the remote area.A total of 110 SD rats were divided into routine flap group (RF,n =40),delay only group (DO,n =30),and delay flap group (DF,n =40) according to the random number table.(1) In group RF,30 rats were selected according to the random number table,and flap surgery was performed directly.Six rats were sacrificed on post operation day (POD) 0,1,2,3,7 respectively to collect the full-thickness skin samples at both CZs for HE staining to measure the vascular density and diameter.The rest 10 rats underwent flap surgery immediately after a catheter was successfully implanted into their external jugular vein.A volume of 1.5 mL sodium fluorescein solution (100 g/L) was injected to the 10 rats on POD 0 (5 rats) or POD 1 (5 rats) each time with a 2-day interval to learn the change in flap circulation.Each rat was injected for 4 times.The flap survival rate of the 10 rats was calculated on POD 7,and the configuration and distribution of the vessels in the flap were observed through angiography with the improved perfusion method of lead oxide-gelatin.(2) In group DO,the right thoracodorsal perforators of all the rats were surgically ligated through a small skin incision,and 6 rats were sacrificed on POD 0,1,2,3,7 respectively.The skin samples of each rat at the same area as in group RF were harvested to measure the vascular density and diameter.(3) In group DF,rats were treated with ligation surgery as in group DO,and then they were assigned and treated as in group RF on POD 7 with corresponding indexes detected later.Data were processed with group t test,analysis of variance with factorial design,and SNK test.Results (1) Significant differences of vascular density at both CZ 1 and CZ 2 were found on POD 7 among the three groups (with F values respectively 2.69 and 2.76,P values below 0.05).The vascular density values of CZ 1 and CZ 2 of rats in group DF were (29 ± 7) and (31±8) per mm2 on POD 7,which were significantly higher than those of group RF [(23 ± 5) and (23 ± 3) per mm2,with q values respectively 5.67 and 6.01,P values below 0.05] and those within group DF on POD 0 (withqvalues respectively 6.42 and 7.14,Pvaluesbelow0.05).On POD3 and7,the vascular diameter values of CZ 1 of rats in groups RF and DF were significantly higher than those of group DO (with q values from 8.15 to 11.13,P values below 0.05).The vascular diameter values of CZ 2 of rats in group DF on POD 0,1,2,3,7 [(65±8),(63±13),(69±9),(67 ±8),(64±13) μm] and in group DO on POD 3 and 7 were significantly higher than those in group RF [respectively (46 ± 10),(40 ± 9),(43±13),(46±12),(47±11) μmonPOD0,1,2,3,7] at corresponding time point (withqvalues from 7.29 to 10.79,P values below 0.05).The difference in vascular diameter between CZ 1 and CZ 2 was statistically significant in groups RF and DO on POD 3 and 7,and in group DF on POD 0,1,and 2 (with q values from 5.32 to 9.56,P values below 0.05).Compared with that on POD 0 within each group,the vascular diameter of CZ 1 in groups RF and DF and that of CZ 2 in group DO increased significantly on POD 3 or7 (with q values from 6.12 to 8.13,P values below 0.05).(2) In groups DF and RF,blood from the pedicle ran through CZ 1 and covered the dynamic territory successfully within POD 7.On POD 0,the blood within all flaps was blocked for about 3 min after going through CZ 1 at 1 cm distal from CZ 2 in group DF and around CZ 2 in group RF.(3) Flap survival rate of rats in group DF was (95 ± 12) ％,which was statistically higher than that of group RF [(80 ±9) ％,t =2.91,P ＜0.01].All the partial flap necrosis occurred in potential territory.(4) Compared with the vessels in the left dorsal side without surgery,the vessels of CZ 1 in group RF were dilated obviously,and the boundary between vascular trees became indistinct,but the vessels in CZ 2 changed slightly; the vessels in both CZs in group DF were dilated dramatically.Conclusions The delay method could enhance the survival of potential territory in perforator flap with three angiosomes,and it acted mainly by dilating the choke vessels in CZ 2 before flap surgery.
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