WS-模拟人体频谱治疗仪对皮瓣存活影响的实验研究

我们采用 WS-模拟人体频谱治疗仪(简称 WS 仪)照射大鼠背部超长随意型皮瓣,连续8天,每天2次,每次30min。结果表明:照射组皮瓣术后第9天存活面积明显大于对照组(P<0.001)。~(99m)Tc 清除率、皮瓣透明标本观察及皮瓣组织匀浆超氧化物歧化酶(SOD)检测说明 WS 仪作用于皮瓣后可使血循环增加,毛细血管扩张、增生,皮瓣组织自由基生成减少。     

WS—模拟人体频谱治疗仪对皮瓣存活影响的实验研究

我们采用ＷＳ－模拟人体频谱治疗仪（简称ＷＳ仪）照射大鼠北部超长随意型皮瓣，连续８天，每天２次，每次３０ｍｉｎ。结果表明：照射组皮瓣术后第９天存活面积明显大于对照组（Ｐ＜０．００１）。＾９＾９ｍＴｃ清除率，皮瓣透明标本观察及皮瓣组织匀浆超氧化物歧化酶（ＳＯＤ）检测说明ＷＳ仪作用于皮瓣后可使血循环增加，毛细血管扩张，增生，皮瓣组织自由基生成减少。     

人脐血来源内皮祖细胞促进裸鼠皮瓣存活的实验研究

目的将内皮祖细胞（endothelial progenitor cell，EPC）引入皮瓣缺血组织中，初步研究其生物学特性及在皮瓣缺血组织中促血管发生的作用。方法采用免疫磁珠法从人脐血中分离培养CD133＋内皮祖细胞，将体外扩增的EPC局部注射于裸鼠超长皮瓣模型中，观察EPC转归及参与皮瓣血管重建的情况；通过观察皮瓣坏死面积及微血管增生情况，评价EPC在皮瓣缺血组织中再血管化能力。结果EPC组皮瓣坏死面积明显小于空白组（P〈0．05）、真皮下层组织灌流量大于对照组（P〈0．05）；荧光示踪及免疫组织化学染色证实EPC参与皮瓣血管重建。结论EPC参与血管重建，具有促进血管新生，加速缺血组织血管化的作用。     

中药对超长皮瓣存活影响的实验研究

采用48只wistar大白鼠,随机应用中药益气注射液与生理盐水对照,研究药物对超长皮瓣(长:宽=6:1)的存活影响。组织学和生化结果表明:中药能提高皮瓣的存活。其作用机理可能是通过改善皮瓣的微循环、稳定组织内环境,从而减少有害物质的产生。     

猪SVN皮瓣成活长度的实验研究

以１２只家猪为模型，形成真皮下血管网皮瓣（ＳＶＮ皮瓣）和筋膜皮瓣，共４８个，大小为７５ｃｍ×３ｃｍ。术后７天筋膜皮瓣成活长度为５．８ｃｍ，ＳＶＮ皮瓣的成活长度为８ｃｍ，较筋膜皮瓣增加了３８％，皮瓣远端愈合类似真皮下血管网皮片。此结果表明，ＳＶＮ皮瓣是超薄超长皮瓣和真皮下血管网皮片的联合体，并对此进行了讨论     

还原型谷胱甘肽对大鼠随意皮瓣成活影响的实验研究

目的通过经大鼠腹腔注射还原型谷胱甘肽(glutathione,GSH),观察其对大鼠随意皮瓣成活的影响,并初步探讨GSH影响皮瓣成活的作用机制。方法选择健康200~250gSD大鼠20只,于背部双侧肩胛下角连线设计制备面积为8cm×2cm随意皮瓣,原位回植。随机分成两组(n=10),实验组于皮瓣术后即刻及1、2d,腹腔注射GSH(250mg/kg),对照组腹腔注射等量生理盐水。术后7d测定皮瓣成活率,取大鼠皮瓣中轴距蒂部3cm处组织,检测超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malonyldialdehyde,MDA)含量,对皮瓣远、中及近段进行组织学观察。结果术后7d,实验组皮瓣成活率为56.77%±10.67%,高于对照组的40.16%±7.12%,差异有统计学意义(P<0.05)。实验组SOD含量为306.06±84.87U/mgprot,高于对照组的224.79±27.12U/mgprot;而MDA含量为3.835±0.457nmol/mgprot,低于对照组的6.127±0.837nmol/mgprot,差异均有统计学意义(P<0.05)。组织学观察:实验组近、中及远段中性粒细胞浸润较对照组明显减轻,其血管、成纤维细胞、毛囊及附属腺体增生均明显优于对照组。结论腹腔注射GSH对大鼠随意皮瓣成活有明显促进作用,作用机制可能与清除自由基、降低脂质过氧化反应及减轻中性粒细胞浸润有关。     

皮瓣延迟后对皮瓣预制时间影响的实验研究

为了探寻缩短皮瓣预制时间的新方法，作者设计了两组皮瓣预制方法进行比较。Ａ组为皮瓣延迟实验组，Ｂ组为正常皮瓣预制对照组。皮瓣预制后２周进行血管灌注检查和皮瓣移植。结果：Ａ组皮瓣成活范围大，植入血管与原皮瓣之间血管吻合支多；Ｂ组皮瓣成活面积小，血管网形成范围小，吻合支少。结论：皮瓣延迟后皮瓣预制时间可大大缩短，从而缩短了手术周期。     

超氧阴离子自由基对皮瓣存活影响的研究

应用电子自旋共振对皮瓣缺血-再灌流过程中产生的超氧阴离子自由基进行了检测,同时观察了该自由基对皮瓣存活的影响。结果表明:皮瓣缺血-再灌流过程中,确实有超氧阴离子自由基的产生,注入其特异性清除剂——SOD后,皮瓣的存活率明显高于对照组。根据实验数据,对皮瓣坏死的病理机制进行了探讨。     

组织扩张对预构轴型皮瓣血供影响的实验研究

目的　研究组织扩张对预构轴型皮瓣血供范围的影响 ,为临床上获取更大面积的预构轴型皮瓣提供理论指导。方法　在同一只兔子腹部的左右侧分别设计、完成以股动、静脉为轴型血管的预构皮瓣 ,右侧腹部仅预构皮瓣未埋置扩张器 (未扩张组 ) ,左侧预构皮瓣下埋置扩张器进行扩张 (扩张组 ) ,分别于预构术后 1、3、5、7、10、14、2 1、2 8、5 6天对扩张组与未扩张组预构皮瓣血供范围进行相关检测。结果　预构皮瓣经扩张后其轴型血管供血范围明显大于未经扩张的预构皮瓣 (P <0 .0 5 )。结论　扩张术可加速皮瓣预构进程 ,增加预构轴型皮瓣的存活面积     

组织扩张对预构轴型皮瓣血供影响的实验研究

目的研究组织扩张对预构轴型皮瓣血供范围的影响,为临床上获取更大面积的预构轴型皮瓣提供理论指导.方法在同一只兔子腹部的左右侧分别设计、完成以股动、静脉为轴型血管的预构皮瓣,右侧腹部仅预构皮瓣未埋置扩张器(未扩张组),左侧预构皮瓣下埋置扩张器进行扩张(扩张组),分别于预构术后1、3、5、7、10、14、21、28、56天对扩张组与未扩张组预构皮瓣血供范围进行相关检测.结果预构皮瓣经扩张后其轴型血管供血范围明显大于未经扩张的预构皮瓣(P＜0.05).结论扩张术可加速皮瓣预构进程,增加预构轴型皮瓣的存活面积.     

水蛭素对大鼠随意型皮瓣存活的影响

目的 研究水蛭素对大鼠背部超长随意型皮瓣存活的影响.方法 采用改良大鼠"McFarlane flap"模型,将实验动物随机分为水蛭素实验组(水蛭素组)和生理盐水对照组(生理盐水组),水蛭素组局部注射3 ml(30 ATU)水蛭素,生理盐水组则注射3 ml生理盐水,连续注射7 d后分别检测两组皮瓣的存活面积百分比,并取皮瓣近、中、远段(即Ⅰ、Ⅱ、Ⅲ区)组织做光镜观察,免疫组化法检测血管内皮生长因子(VEGF)和碱性成纤维细胞因子(bFGF)的表达.结果 术后7 d,水蛭素组皮瓣的存活面积百分比为(69.52±3.23)%,生理盐水组为(50.36±2.37)%,水蛭素组显著高于生理盐水组,差异有统计学意义(P＜0.01);水蛭素组皮瓣坏死与存活并存的Ⅱ区,组织水肿、炎性细胞浸润情况明显比生理盐水组轻.水蛭素和生理盐水组皮瓣Ⅱ区的新生血管计数分别为(28.24±4.23)个/mm2和(17.45±5.43)个/mm2,两组比较差异有统计学意义(P＜0.05).通过计算累积吸光度A值(IA),得到水蛭素和生理盐水组VEGF阳性量分别为9262.23±896.99和4938.05±1623.67,bFGF阳性量分别为5122.83±1176.12和2779.45±472.00,水蛭组VEGF及bFGF的表达均高于生理盐水组,差异均有统计学意义(P＜0.01).结论 水蛭素可能通过体内一系列复杂的调控通路,最终增加VEGF、bFGF表达,促进皮瓣新生血管增生,改善皮瓣血供,减轻炎性反应,降低缺血皮瓣的坏死率,从而提高大鼠随意型皮瓣的存活.

Abstract：

Objective To investigate the effect of Hirudin on random skin flap survival in rats.Methods 24 SD rats were randomly divided into control group and experimental group. The "McFarlane flap(3 cm ×9 cm)" rat models were established on the rat dorsum. 3 ml Hirudin (30 ATU) was injected into the flap in the experimental group, while 3 ml saline in the control group. The injection was performed for 7 days. The flap survival area in the two groups was measured. The tissue samples were taken from proximal( Ⅰ ), middle( Ⅱ ) and distal( Ⅲ ) portions of flaps for histologic study. The VEGF and bFGF expression was also detected with immunohistochemistry method. Results 7 days after operation, the flap survival rate was ( 69.52 + 3.23 )% in the experimental group, while ( 50.36 ± 2.37 )% in control group,showing a significant difference between the two groups ( P ＜ 0.01 ). In the middle portion, tissue edema and infiltration of neutrophils in experimental group was markedly slighter than that in control group. The VEGF and bFGF expression and neovascularization was enhanced markedly in experimental group.Conclusions Hirudin can increase the survival of random pattern skin flaps. It may increase the VEGF,bFGF expression through a series of complex regulatory pathway. Then flap neovascularization is promoted and the flap blood supply is increased.     

猪狭长窄蒂随意型皮瓣蒂部不同长宽比例与成活面积关系的研究

目的 探讨狭长窄蒂随意型皮瓣蒂的长宽比例与皮瓣成活面积的关系,为临床应用狭长窄蒂皮瓣提供理论依据.方法 将25只猪随机分成5组,每组5只,5组皮瓣蒂的长、宽比分别为0∶2,1∶2,2∶2,3∶2,4∶2,每个长宽比例的狭长窄蒂均携带5个不同面积的随意型皮瓣,分别为2 cm×2 cm、3 cm×3 cm、4 cm×4 cm、5 cm×5 cm、6 cm×6 cm,并依次命名为A、B、C、D、E,其中A瓣为B、C、D、E瓣的对照瓣,在每组每只猪的双侧背部均形成A、B、C、D、E皮瓣,顺序排列但两侧背部相反.对每组皮瓣进行大体观察、荧光色素钠染色、ECT血流测定、病理学表现和成活面积分析等.结果 ①狭长窄蒂随意型皮瓣和常规随意型皮瓣的成活过程和病理过程是一致的,皮瓣的成活过程并未因蒂部变窄变长而延缓.②当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定界限时皮瓣远端即发生坏死,而成活面积并未缩小.③当皮瓣大小不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定界限时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 ①随意型皮瓣的蒂宽可远远小于瓣宽,蒂宽和瓣长比可远小于传统的比例.②随意型皮瓣的蒂部可以设计成狭长状,使整个皮瓣形似"乒乓球拍",更利于皮瓣的旋转.③不同长宽比的狭长窄蒂所能携带的随意型皮瓣成活面积有其最大值,一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.

Abstract：

Objective To explore the relationship between the ratio of length to width of slender narrow pedicle and random flap survival area, and to provide a theoretical basis for the clinical application of slender narrow pedicle flaps. Methods 25 pigs were randomly divided into 5 groups, 5 pigs in each group. The ratio of length to width of slender narrow pedicle in 5 groups respectively was: 0∶2 , 1∶2 ,2∶2, 3∶2, 4∶2 . Every ratio's slender narrow pedicle was carrying five different size of random flaps,which were2cm×2cm(A),3 cm×3 cm(B),4 cm×4 cm(C), 5 cm×5 cm(D),6 cm×6 cm(E),respectively. Flap A was control flap. In each group, flap A, B, C, D and E were created in each pigs'bilateral back. The order in both sides back is contrary. The flaps were evaluated with the general observation, fluorescence examination, blood flow ECT test, pathological expression and computerized analysis of survival area. Results ① The living process and pathologic process of traditional flap and slender narrow pedicle flap were consistent. It could not postpone the flap living process when the flap pedicle became long and narrow. ② When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area , the distal flap would necrosis, the flap survival area would not reduce. ③ When the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would necrosis, the flap survival area would reduce.Conclusions ① Pedicle width of random flap can be much smaller than flap width. The ratio of pedicle width to flap length is far less than traditional ratio. ② The pedicle of random flap can be designed as slender shape, so that the whole flap looks like "pingpang bat ", which makes the narrow pedicle flap rotate easily. ③ A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flapsize or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.     

疏血通注射液对大鼠随意型皮瓣存活的影响

目的研究疏血通注射液对大鼠背部随意型皮瓣存活的影响。方法采用改良的大鼠McFarlane皮瓣制作方法,将Sprague Dawley大鼠随机分为疏血通实验组和生理盐水对照组,实验组每只每天腹腔注射疏血通注射液1．5mL／kg,对照组每只每天腹腔注射生理盐水1．5mL／kg。术后第7天处死大鼠分别进行皮瓣存活面积比的检测,并取皮瓣近、中、远区组织切片光镜下观察,免疫组化法检测血管内皮生长因子（VEGF）的表达。结果术后7d,实验组皮瓣的存活面积比为（72．52±2．23）％,对照组皮瓣的存活面积比为（50．36±2．37）％,实验组存活面积比显著高于对照组（P〈0．01）。实验组中区皮瓣的组织水肿、炎症细胞浸润情况明显比对照组减轻,并且出现大量的新生血管,中区新生血管密度（27．42±4．21）个／mm^2,与对照组（17．45±5．43）个／mm^2差异有统计学意义（P〈0．05）。实验组VEGF表达量为4731．24±448．99,对照组为2466．01±801．67,差异有统计学意义（P〈0．01）。结论疏血通注射液可能通过增加VEGF表达等途径,促进皮瓣新生血管增生,改善皮瓣血供,减轻炎症反应,从而改善大鼠随意型皮瓣的存活。     

Effects of low-power laser irradiation on survival of random skin flap in rats

This research was designed to study the effects of low-power helium–neon (He–Ne) laser irradiation on random skin flap survival in rat. Fifty 50 male rats were randomly divided into five groups. On the dorsum of each rat, one full thickness random skin flap which contained no specific vessel was elevated. Groups 1 to 4 were exposed to different models of a low-power He–Ne laser. Group 5 rats received no laser treatment and were considered as the control group. The energy density of the He–Ne laser used was 0.2 J/cm². Immediately after surgery and at day 7, the surface area of all flaps was determined. Histological and tensiometrical studies on the surviving part of the flaps were also performed. The data obtained were analyzed by ANOVA. The results showed a significant difference in the surface area of survival parts of flaps and density of blood vessels on day 7 between group 3 rats and the other groups (P=0.0188, P=0.0455). Low-power He–Ne laser irradiation of flaps without recognized blood vessels in rats, reduced vasospasm, produced vasodilation, and caused a significant increase in the surviving surface area.Presented at the 14th World Congress of the International Society for Laser Surgery and Medicine, India, 27–30th August, 2001     

电脉冲介导的血管内皮细胞生长因子基因治疗对大鼠随意型皮瓣成活的影响

目的探讨血管内皮细胞生长因子(vascularendothelialgrowthfactor,VEGF)质粒直接皮下注射,结合直流电脉冲刺激的基因治疗方案的血管生成效应及不同剂量质粒对皮瓣成活的影响。方法设计大鼠随意皮瓣模型,利用直流电脉冲将皮下注射的重组质粒PCMVMCSVEGFIRES2EGFP导入缺血皮瓣内。观察皮瓣成活的情况,利用苏木素伊红(HE)染色,观察VEGF基因的血管生成效应。结果皮下直接注射结合直流电脉冲成功地将重组质粒导入皮肤。基因转染后7d观察到明显的血管增生。基因治疗组皮瓣成活面积[80μg为(77.38±4.56)%,400μg为(82.57±5.21)%]显著大于对照组[(48.96±4.32)%]。但两基因治疗组皮瓣成活面积差异无统计学意义。结论VEGF质粒直接皮下注射结合直流电脉冲刺激能够高效转染大鼠皮肤,具有明显的血管生成效应,能够显著促进大鼠随意型皮瓣的成活。质粒的剂量对皮瓣成活的影响差异无统计学意义。     

氨氯地平经皮肤渗透给药对缺血随意型皮瓣成活的影响

目的 探讨氨氯地平水凝胶(amlodipine gel)经皮肤渗透给药及其对大鼠缺血随意型皮瓣成活的影响.方法 制备0.5％、1.0％、1.5％、2.0％和2.5％氨氯地平水凝胶.用改良的Franz扩散池测定氨氯地平经大鼠皮肤的累积渗透量.在大鼠缺血随意型皮瓣外用氨氯地平水凝胶7d后,测定皮瓣的成活面积和给药后第2、6小时皮瓣组织中氨氯地平的含量.结果 氨氯地平的累积渗透量随氨氯地平浓度和渗透时间增加而增加(P＜0.05).0.5％、1.0％氨氯地平水凝胶中的氨氯地平的累积渗透量＜1.5％、2.0％、2.5％氨氯地平水凝胶(P＜0.05).1.5％氨氯地平水凝胶组皮瓣组织内氨氯地平的含量均＞0.5％氨氯地平水凝胶组(P＜0.05).0.5％氨氯地平水凝胶组皮瓣的成活面积为(391.4±65.4) mm2,高于凝胶基质对照组的(192.9±56.8) mm2及空白对照组的(191.0±50.2)mm2(P＜0.05),但1.5％氨氯地平水凝胶组皮瓣(265.7±88.3)mm2与两对照组间差异无显著统计学意义(P＞0.05).结论 氨氯地平可渗透进入皮肤组织;0.5％氨氯地平水凝胶可显著提高缺血随意型皮瓣的成活面积.     

地拉罗司对成年大鼠狭长窄蒂皮瓣DLL4、CD105表达及血管新生的影响

目的 探讨地拉罗司对成年大鼠狭长窄蒂皮瓣Delta样配体4(DLL4)、CD105表达及血管新生的影响.方法 健康成年SD大鼠20只随机分为地拉罗司组和对照组(n=10).地拉罗司组每只大鼠采用地拉罗司100 mg·kg-1·d-1连续灌胃1周,对照组采用等量生理盐水连续灌胃1周.灌胃停止后,两组每只大鼠背部左右各设计1个蒂部为1 cm×1 cm、瓣部为3 cm×3 cm的狭长窄蒂乒乓球拍样随意型皮瓣模型.手术1周后分别取各个皮瓣蒂部、皮瓣部中间位置组织1 cm×1 cm,以10％甲醛溶液固定,免疫组织化学(SABC法)分别检测CD105和DLL4.结果 地拉罗司组与对照组相比,无论在蒂部或是在皮瓣部,大鼠皮瓣组织内CD105标记的新生血管均增多,DLL4表达的新生血管均减少.两组中,皮瓣部组织中CD105、DLL4标记的新生血管均多于蒂部.结论 地拉罗司促进狭长窄蒂皮瓣中的CD105表达、促进血管新生,并且可能与其抑制皮瓣Notch途径中关键蛋白DLL4的表达有关.     

猪背部乒乓球拍样任意型皮瓣成活的动物实验研究

目的 探讨乒乓球拍样任意型皮瓣成活面积与窄蒂长宽比例关系.方法 25只猪随机分成5组,在5组猪的背部分别形成不同长宽比例的狭长窄蒂和5个不同面积的任意型皮瓣.对每组皮瓣进行大体观察、荧光色素钠染色、单光子发射计算机断层仪（ECT）血流量测定、成活面积分析等.结果 当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定限度时皮瓣远端即发生坏死,而成活面积并未缩小;当皮瓣面积不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定限度时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 狭长窄蒂任意型皮瓣是一种简便实用的任意型皮瓣,蒂部可以设计成狭长状,蒂瓣的长宽比远小于传统的比例,在一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

Effect of aspirin on random pattern flap survival in rats

Aspirin is known to increase dermal perfusion and is commonly used to enhance anastomotic patency in microvascular surgery. However, we were unable to find any reports of an effect of aspirin on simple flap survival. In order to determine its effect on flap survival, a controlled experiment was designed using random pattern flaps in rats. The results indicate a statistically significant increase in flap survival in rats receiving aspirin. It is suggested that aspirin’s anti-aggregation effect, in combination with its vasodilatational and anti-inflammatory effect, increases the perfusion in the initial critical hours and thus secondarily decreases the reperfusion injury. Received: 21 January 1999 / Accepted: 28 June 1999