皮蒂在穿支筋膜蒂皮瓣中的作用探讨

doi:10.13418/j.issn.1001-165x.2019.01.008

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (1): 34-39.doi: 10.13418/j.issn.1001-165x.2019.01.008

皮蒂在穿支筋膜蒂皮瓣中的作用探讨

庄家正¹，　王开放²，　刘敏敏¹，　林奕楠¹，　鲍文珍¹，　王锋²，　郑海波³，　方芳²，　庄跃宏²

1. 福建医科大学临床医学部，福州 350108；　2. 福建医科大学基础医学院人体解剖学与组织胚胎学系，福州 350108；
3. 福建医科大学基础医学院数理与计算机教学部，福州 350108

收稿日期:2018-09-19 出版日期:2019-01-25 发布日期:2019-02-20
通讯作者: 王锋，副教授,Tel：0591-22862876，E-mail：fjwf95168@163.com；郑海波，讲师，Tel：18950478230，E-mail：wa.ve@163.com
作者简介:庄家正（1997-），福建泉州人，本科生，主要从事皮瓣血供的基础研究，E-mail：529791535@qq.com
基金资助:
福建省自然科学基金面上项目（2016J01705）；福建省中青年教师教育科研项目（JAT160188）；福建医科大学国家级大学生创新项目（201710392003）

The role of skin base in perforator-plus flap survival

ZHUANG Jia-zheng¹, WANG Kai-fang², LIU Min-min¹, LIN Yi-nan¹, BAO Wen-zhen¹, WANG Feng², ZHENG Hai-bo³, FANG Fang², ZHUANG Yue-hong²

1. School of Clinical Medicine, Fujian Medical University, Fuzhou 350108, China；2. Department of Human Anatomy and Histoembryology, School of Basic Medicine, Fujian Medical University, Fuzhou 350108, China； 3.Department of Mathematics Physics and Computer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350108, China

Received:2018-09-19 Online:2019-01-25 Published:2019-02-20

摘要/Abstract

摘要：

目的　进一步阐明穿支筋膜皮瓣的皮蒂对皮瓣的静脉引流和动脉输入的作用。方法　40只重约300g的雄性SD大鼠,在背部切取大小为9 cm×3 cm的皮瓣后,等分入以下4组: 穿支完好组(蒂部穿支保留完好)、动脉缺失组(结扎蒂部动脉)、静脉缺失组（结扎蒂部静脉）及穿支缺失组（结扎动静脉）。术后7 d使用激光多普勒血流仪监测皮瓣血液灌注，计算皮瓣坏死率，测量皮蒂血管的直径。结果　激光多普勒血流仪提示穿支完好组与静脉缺失组的灌注模式相似，穿支缺失组与动脉缺失组的灌注模式相似。穿支完好组和静脉缺失组的血流灌注量更大。穿支缺失组皮瓣的坏死率（26±1）%与动脉缺失组皮瓣的坏死率（29±1）%无显著差异，但均显著高于穿支完好组（11±3）%和静脉缺失组（12±4）%皮瓣的坏死率（P<0.001）。静脉缺失组和穿支缺失组的皮肤基底部静脉网明显扩张，而动脉缺失组和穿支完好组的动脉网管径轻度增大。结论　穿支筋膜皮瓣的皮蒂作为静脉引流额外通道的作用比其作为动脉输入的作用更加重要。

关键词: 皮瓣, 　穿支, 　皮蒂, 　choke血管

Abstract:

Objective　To investigate the exact role of a skin pedicle in serving arterial perfusion or venous outflow in flap survival.　Methods　40 male SD rats weighing 300g were used in this study and divided into the following 4 groups after harvesting of a flap with a size of 9×3cm on the back: perforator-complete group (perforator preserved in the pedicle), artery-deficit group (ligation of the perforating artery), vein-deficit group (ligation of the perforating vein), and perforator-deficit group（ligation of the perforator）. A laser Doppler flowmeter was used to monitor the flap perfusion after surgery, and the flap necrosis rate was calculated and the vascular diameter at the skin pedicle was measured at day 7.　Results　The data of the laser Doppler flowmeter indicated a similar perfusion pattern between the perforator-complete group and the vein-deficit group, as well as between the perforator-deficit group and the artery-deficit group. The perfusion in the perforator-complete group and the vein-deficit group was much stronger. The necrosis rate was (26±1) % in the perforator-deficit group, which was not significantly different from the necrosis rate of being (29±1) % in the artery-deficit group, both of which were significantly larger than the necrosis rate being (11±3)% and (12±4)%, respectively, in the perforator-complete group and the vein-deficit group（P<0.001）.　The venous network in the skin base was extremely dilated in the skin base in the vein-deficit and perforator-deficit group, whereas the arterial network was modestly dilated in the artery-deficit and perforator-complete group. Conclusion　The skin base in the perforator-plus group is more important as an additional route for venous backflow than as an additional arterial input.

Key words: , Flap；　Perforator；　Skin pedicle；　Choke vessels

庄家正,王开放,刘敏敏,林奕楠,鲍文珍,王锋,郑海波,方芳,庄跃宏. 皮蒂在穿支筋膜蒂皮瓣中的作用探讨[J]. 中国临床解剖学杂志, 2019, 37(1): 34-39.

ZHUANG Jia-zheng, WANG Kai-fang, LIU Min-min, LIN Yi-nan, BAO Wen-zhen, WANG Feng, ZHENG Hai-bo, FANG Fang, ZHUANG Yue-hong. The role of skin base in perforator-plus flap survival[J]. Chinese Journal Of Clinical Anatomy, 2019, 37(1): 34-39.

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皮蒂在穿支筋膜蒂皮瓣中的作用探讨

The role of skin base in perforator-plus flap survival

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