不同蒂型静脉皮瓣成活率的实验研究

目的 探索提高静脉皮瓣成活率的手术方法.方法 以新西兰白兔为实验动物模型,分别制成单蒂无输出型（A组）、双蒂主干输出型（B组）、双蒂属支输出型（C组）和三蒂属支输出型（D组）4种静脉皮瓣,通过观测皮瓣的成活面积、检测丙二醛（malondialdehyde,MDA）含量、组织学检查,比较不同蒂型静脉皮瓣成活率并初步探讨其成活机理.结果 A、B、C、D各组皮瓣的成活率依次增高,后两者之间差异无统计学意义,其余组间差异均有统计学意义;反之皮肤组织MDA含量术后8～24h增长幅度按D、C、B、A依次递增,组间差异均有统计学意义;组织形态学检查显示A、B两组皮瓣上皮细胞较多的线粒体空泡样变性,嵴部分消失,染色质边集,不同程度的核固缩.C和D组此种改变轻微.结论 双蒂属支和三蒂属支输出型静脉皮瓣,能缓解静脉皮瓣的高张力水肿和维持血流的有效灌注,有助于提高静脉皮瓣的成活率.

Experimental study on the survival of venous flap with different pedicle styles

OBJECTIVE: To study a new method of venous flap that is improved on its persistence and quality. METHODS: New Zealand white rabbits were subdivided randomly into 4 groups. All rabbits were operated by harvesting a flap from the latero-abdominal wall and then sutured it in the original position. Group A: the superficial epigastric vein in the pedicle was left open (only one inflow vein remained). Group B: the pedicle vein of the proximal and distant end were left open (keeping an inflow vein and a principal out). Group C: the pedicle vein and a tributary vein were left open (keeping an inflow vein and a tributary outflow vein). Group D: the pedicle vein and two tributary veins were left open (keeping an inflow vein and two tributary outflow veins). Survival rate, MDA of the tissue, histology and ultra-microstructure were examined. RESULTS: Survival rate of A, B, C, D were improved in order. Statistic difference is significant (P < 0.05) between group and group other than C and D. The content of MDA was heightened with statistically significant differences (A > B > C > D) among the four groups 8 hours postoperatively, but fell back to the normal level in group D and C and kept a high level in group A and B at 72 hour postoperatively. Histology and ultra-microstructure exam showed that degeneration of collagen fiber and karyopyknosis of cell is more obvious in Group A and Group B than Group C and Group D. CONCLUSIONS: The higher survival rate of venous flap is possible by designing the more reasonable venous flap outputs pedicles which can alleviate the high tension dropsy and maintain the valid equilibrium of pour with flow in the venous flap.