CAJ | 학술논문

目的研究负压引流对扩张皮瓣血液循环的影响,以指导临床在耳廓再造中合理有效使用负压引流技术.方法将21例耳廓再造患者随机分为A、B、C 3组,分别给予-20、-40和-60 kPa负压引流,并于术后即刻、5和10 d分别测量计算3组患者再造耳廓的长、宽之差值,以间接了解再造耳廓肿胀和皮瓣静脉回流情况.术后采用红外热像仪检测再造耳廓于0、-20、-40和-60 kPa负压下皮瓣近(耳甲腔)、远端(耳轮缘)的温度变化.结果 B组术后5d再造耳廓的长、宽差值分别为(1.48±0.47) mm和(0.36±0.06) mm,明显小于术后即刻的(1.67±0.69) mm和(0.40±0.16) mm;A、C组也有差别,但并无统计学意义(P＞0.05).B组术后10 d再造耳廓的长、宽差值分别为(1.31 ±0.42) mm和(0.48±0.04)mm,与术后5d比较,差异有统计学意义(P＜0.01);而A、C2组比较,差异无统计学意义.再造耳廓皮瓣肿胀程度随负压值增大,呈现先下降后增加的趋势(P＜0.01);扩张器自体肋软骨耳廓再造术负压引流强度在0～60 kPa范围内,随负压强度增大,再造耳廓皮瓣温度升高(P＜0.01);且近端温度的增加大于远端,差异有统计学意义(P＜0.01).结论负压引流对再造耳廓皮瓣静脉回流及动脉供血均有影响,-40 kPa负压对再造耳廓动脉供血及静脉回流均有促进作用,可为临床设定负压引流强度提供参考.
목적 연구부압인류대확장피판혈액순배적영향,이지도림상재이곽재조중합리유효사용부압인류기술.방법 장21례이곽재조환자수궤분위A、B、C 3조,분별급여-20、-40화-60 kPa부압인류,병우술후즉각、5화10 d분별측량계산3조환자재조이곽적장、관지차치,이간접료해재조이곽종창화피판정맥회류정황.술후채용홍외열상의검측재조이곽우0、-20、-40화-60 kPa부압하피판근(이갑강)、원단(이륜연)적온도변화.결과 B조술후5d재조이곽적장、관차치분별위(1.48±0.47) mm화(0.36±0.06) mm,명현소우술후즉각적(1.67±0.69) mm화(0.40±0.16) mm;A、C조야유차별,단병무통계학의의(P＞0.05).B조술후10 d재조이곽적장、관차치분별위(1.31 ±0.42) mm화(0.48±0.04)mm,여술후5d비교,차이유통계학의의(P＜0.01);이A、C2조비교,차이무통계학의의.재조이곽피판종창정도수부압치증대,정현선하강후증가적추세(P＜0.01);확장기자체륵연골이곽재조술부압인류강도재0～60 kPa범위내,수부압강도증대,재조이곽피판온도승고(P＜0.01);차근단온도적증가대우원단,차이유통계학의의(P＜0.01).결론 부압인류대재조이곽피판정맥회류급동맥공혈균유영향,-40 kPa부압대재조이곽동맥공혈급정맥회류균유촉진작용,가위림상설정부압인류강도제공삼고.
Objective To investigate the effect of vaccum drainage on blood circulation of expanded skin flap,so as to confirm suitable negative pressure for ear reconstruction.Methods 21 patients (Auricular Reconstructive Center of Plastic Surgery Hospital,PUMC) were randomly divided into A,B,C 3 groups to receive vaccum drainage of:-20,-40 and-60 kPa,respectively.The length and width of reconstructed ears,which represented the swelling degree,were measured instantly and 5,10 days postoperatively.The changes were calculated and reflected venous drainage of flaps.The temperature of proximal (concha) and distal (helix) part of the expanded flaps,which represented the arterial blood supply of flaps,was detected by infrared thermography after operation.Results Five days after operation [(1.48±0.47) mm,(0.36 ±0.06) mm] and immediately[(1.67 ±0.69) mm,(0.40 ±0.16) mm)],the changes of the length and width of reconstructed ear in group B was significantly low,while there was no statistically difference between group A and C (P ＞ 0.05).The data between 10 days and 5 days after operation showed the same result.Along with the increase of the negative pressure,the swelling degree of reconstructed ears decreased firstly and then increased reversely (P ＜ 0.01).The flap temperature of reconstructed ears in creased(P ＜0.01),especially in proximal(concha) part(P ＜0.01),when the negative pressure increased (0 to-60 kPa).Conclusions Vacuum drainage has effect on both the venous drainage and blood supply.Negative pressure of-40 kPa can improve both the blood supply and venous drainage.It should be as reference for clinical application.