联体皮瓣的静脉引流位置对动脉血流导向功能的影响

doi:10.16098/j.issn.0529-1356.2018.05.015

解剖学报 ›› 2018, Vol. 49 ›› Issue (5): 651-656.doi: 10.16098/j.issn.0529-1356.2018.05.015

联体皮瓣的静脉引流位置对动脉血流导向功能的影响

程晟¹ 习珊珊² 林东辉¹何耀之¹ 薛斌伟³ 唐茂林⁴毛以华^4*

1. 温州医科大学仁济学院，浙江温州 325035; 2. 长江大学医学部人体解剖学教研室，湖北荆州 434023; 3. 温州医科大学附属第一医院放射科，浙江温州 325035; 4. 温州医科大学人体解剖学教研室，浙江温州 325035

收稿日期:2017-08-30 修回日期:2017-12-23 出版日期:2018-10-06 发布日期:2018-10-06
通讯作者: 毛以华 E-mail:maoyihua721@163.com
基金资助:
浙江省大学生科技创新项目;浙江省自然科学基金;国家自然基金

Influence of venous drainage position on arterial blood flow in the conjoined flap

CHENG Sheng¹Ⅺ Shan-shan² LIN Dong-hui¹ HE Yao-zhi¹ XUE Bin-wei³ TANG Mao-lin⁴ MAO Yi-hua ^4*

1. Wenzhou Medical University Renji College, Zhejiang Wenzhou 325035, China; 2. Department of Human Anatomy, Yangtze University School of Medicine, Hubei Jingzhou 434023, China; 3. Radiology Department, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325035, China; 4. Department of Anatomy, Wenzhou Medical University, Zhejiang Wenzhou 325035, China

Received:2017-08-30 Revised:2017-12-23 Online:2018-10-06 Published:2018-10-06
Contact: MAO Yi-hua E-mail:maoyihua721@163.com

摘要/Abstract

摘要：

目的探讨联体皮瓣的静脉引流位置对动脉血流导向功能的影响。方法将72只SD大鼠随机分为4组:正常组不做任何处理；对照组仅保留右侧肋间后动、静脉；实验组1仅保留右侧肋间后动脉+左侧肋间后静脉；实验组2仅保留右侧肋间后动脉+左侧髂腰静脉。测量血管体之间距离。术后7 d，统计皮瓣存活率以及明胶氧化铅血管造影观察皮瓣区血管形态；choke 1区取材，HE染色，分析动脉管径扩大倍数；尾静脉采血，检测乳酸含量。结果血管体Ⅰ离Ⅱ最近，离Ⅲ最远，差异有统计学意义（P<0.05）。术后7 d，对照组皮瓣存活率为（86.5±4.3）%，实验组1和实验组2皮瓣存活率均为100%；血管造影显示，在血管体Ⅲ与Ⅳ区域，对照组血管增生比较少，而实验组1比较明显，实验组2最明显；与正常组相比，实验组2动脉管径扩大最明显，其次为实验组1，差异有统计学意义（P<0.05）；对照组乳酸含量最高，差异有统计学意义（P<0.05）。结论静脉引流位置的改变可造成动脉灌流与静脉引流效果的改变，进而改变皮瓣区域生理性血管网，提高存活率。

关键词: 动脉灌流, 静脉引流, 联体皮瓣, 血管体, 静脉位置, 血管分离, 明胶氧化铅血管造影, 大鼠

Abstract:

Objective To investigate the influence of venous drainage position on the direction of arterial blood flow in the conjoined flap. Methods Seventy-two Sprague-Dawley rats were randomly divided into four groups: normal group received no treatment; the control group only remained the right intercostal posterior artery and vein; experimental group 1 only remained the right intercostal posterior artery and the left intercostal posterior vein, and experimental group 2 only remained the right intercostal posterior artery and the left iliolumbar vein. The distance among the angiosomes was measured. At day 7 after surgery, the survival rate of the flap was measured and the morphology of vessels by lead oxide-gelatin angiography was observed. Materials from the choke-area 1 was drawn, HE staining was used to compare the diameter expansion of the artery. Blood from the tail vein was collected, and the contents of lactate was detected. Results The distance of angiosomeⅠtoⅡ was nearest, Ⅰ to Ⅲ was farthest, the difference was statistically significant (P<0.05). At day 7 after surgery, the survival rate of the control group was (86.5±4.3) percent, while 100 percent in experimental groups 1 and 2. Angiography showed that the number of blood vessels was relatively small in control group, larger in experimental group 1, and the largest in experimental group 2 in regions of angiosome Ⅲ and Ⅳ. Compared to the normal group, the diameter of the artery of the experimental 2 was most obviously expanded, followed by the experimental group 1, the difference was statistically significant (P<0.05). The lactate contents in the control group was the highest, the difference was statistically significant (P<0.05). Conclusion Changes in position of venous drainage can result in the changes of the effect of arterial perfusion and venous drainage, and then alter the vascular rete, improve the flap survival.

Key words:

Arterial perfusion, Venous drainage, Conjoined flap, Angiosome, Venous position, Angiodiastasis, Gelatin lead oxide angiography, Rat

程晟习珊珊林东辉何耀之薛斌伟唐茂林毛以华. 联体皮瓣的静脉引流位置对动脉血流导向功能的影响[J]. 解剖学报, 2018, 49(5): 651-656.

CHENG Sheng Ⅺ Shan-shan LIN Dong-hui HE Yao-zhi XUE Bin-wei TANG Mao-lin MAO Yi-hua. Influence of venous drainage position on arterial blood flow in the conjoined flap[J]. Acta Anatomica Sinica, 2018, 49(5): 651-656.

参考文献

［1］Zelken JA, Aldeek NF, Hsu CC, et al. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps［J］. Microsurgery, 2016, 36(2): 104-114.

［2］Ciudad P, Maruccia M, Orfaniotis G, et al. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction［J］. Microsurgery, 2016, 36(5): 359-366.

［3］Mourad MW, Su HK, Castro JR, et al. Staged laryngeal reconstruction with a prefabricated flap for radiation recurrent glottic carcinoma［J］. Laryngoscope, 2016, 126(5): 1061-1070.

［4］Roberts AP, Cohen JI, Cook TA. The rat ventral island flap: a comparison of the effects of reduction in arterial inflow and venous outflow［J］. Plast Reconstr Surg, 1996, 97(3): 610-615.

［5］Tanaka Y, Tajima S. The influence of arterial inflow and venous outflow on the survival of reversed-flow island flaps: an experimental study［J］. Plast Reconstr Surg, 1997, 99(7): 2021-2029.

［6］Yazar S, Chen HC, Mardini S. Augmentation of venous drainage by a venous anastomosis for pedicled flaps［J］. J Reconstr Microsurg, 2008, 24(5): 369-376.

［7］Talbot SG, Pribaz JJ. First aid for failing flaps［J］. J Reconstr Microsurg, 2010, 26(8): 513-515.

［8］Fujiwara M, Nagata T, Matsushita Y, et al. Delayed distally based sural flap with temporary venous supercharging［J］. Microsurgery, 2013, 33(7): 534-538.

［9］Tao Y, Ding M, Wang A, et al. Basic perforator flap hemodynamic mathematical model［J］. Plast Reconstr Surg Glob Open, 2016, 4(5): e714.

［10］Lou XF, Mei J, Tang ML, et al. Modified lead oxide-gelatin injection technique for angiography［J］. Chinese Journal of Clinical Anatomy, 2006, 24(3): 259-262. (in Chinese)

楼新法, 梅劲, 唐茂林, 等. 明胶氧化铅血管造影术的优化［J］. 中国临床解剖学杂志, 2006, 24(3): 259-262.

［11］Taylor GI, Pan WR. The Angiosome Concept and Tissue Transfer［M］. St. Louis, Mo: Quality Medical Publishing, 2014: 432-450.

［12］Zhang YX, Wei ZR, Chen W, et al. Influence of different diameters of proximal blood vessels on survival areas of the perforator flap［J］. Chinese Journal of Medical Aesthetics and Cosmetology, 2016, 22(5): 296-299. (in Chinese)

张永祥, 魏在荣, 陈伟, 等. 不同直径近段血管对穿支皮瓣成活面积的影响［J］. 中华医学美学美容杂志, 2016, 22(5): 296-299.

［13］Kim CY, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps［J］. Plast Reconstr Surg, 2012, 130(1): 135-144.

［14］Zheng J, Xi ShSh, Li H, et al. Comparison between venous superdrainage and arterial supercharging on flap survival［J］. Acta Anatomica Sinica, 2016, 47(3): 359-364. (in Chinese)

郑俊, 习珊珊, 李红, 等. 静脉超引流与动脉增压对皮瓣存活的影响［J］. 解剖学报, 2016, 47(3): 359-364.

［15］Hallock GG, Rice DC. Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model［J］. Plast Reconstr Surg, 2005, 116(2): 551.

［16］Fujiwara M, Nagata T, Matsushita Y, et al. Delayed distally based sural flap with temporary venous supercharging［J］. Microsurgery, 2013, 33(7): 534-538.

［17］Herlin C, Bekara F, Bertheuil N, et al. Venous supercharging reduces complications and improves outcomes of distally based sural flaps［J］. J Reconstr Microsurg, 2017, 33(5): 343-351.

［18］Ueda K, Harashina T, Oba S, et al. Which vessel is more important in the supercharged flap- -artery, vein, or both? An experimental study［J］. J Reconstr Microsurg, 1994, 10(3): 153-155.

［19］Chang H, Nobuaki Ⅰ, Minabe T, et al. Comparison of three different supercharging procedures in a rat skin flap model［J］. Plastic Reconstr Surg, 2004, 113(1): 277-283.

［20］Chen W, Li YQ, Zhan Y, et al. Which vessel, the artery or the vein is more important in vascular supercharge: an investigation of vascular changes on rat abdominal supercharging flap models［J］. Chinese Journal of Plastic Surgery, 2013, 29(1): 40-44. (in Chinese)

陈文, 李养群, 詹勇, 等. 大鼠腹部增压皮瓣模型中动、静脉增压作用的研究［J］. 中华整形外科杂志, 2013, 29(1): 40-44.

［21］Hanasono MM, Kocak E, Ogunleye O, et al. One versus two venous anastomoses in microvascular free flap surgery［J］. Plastic Reconstr Surg, 2010, 126(5): 1548-1557

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联体皮瓣的静脉引流位置对动脉血流导向功能的影响

Influence of venous drainage position on arterial blood flow in the conjoined flap

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