穿支皮瓣Choke区动、静脉血流阻力对皮瓣存活的影响

doi:10.13418/j.issn.1001-165x.2018.06.010

Abstract

Abstract:

Objective　To investigate the arterial resistance and venous resistance of blood flow across the choke vessels and their effects on the survival of perforator flap, through comparative study of the arterial and venous resistance in the same group of flaps.　Methods　Thirty-four Sprague-Dawley rats were randomly divided into two groups: group A preserved the right intercostal posterior artery and the left intercostal posterior vein, and group B preserved the right intercostal posterior artery and the right iliolumbar vein. The distance between the reserved artery and vein was measured. At day 7 after surgery, the survival rate of the flap was measured and the microvascular morphology was observed through lead oxide-gelatin angiography; Tissues were harvested from the choke area, which then underwent H＆E staining to measure the average microvascular density; Moreover, blood was collected from the tail vein for detection of the contents of lactate.　Results　The distance between the preserved artery and vein in group A was shorter than that in group B, the difference was statistically significant (P<0.05). At day 7 after surgery, the survival rate of group A was 100 percent, while in group B the survival rate of angiosome 1, angiosome 4 and the whole flap was（67.0±13.1）%, 100% and （88.0±6.8）%, respectively; the angiogenesis was more obvious in group A than that in group B, and the difference was statistically significant (P<0.05); the lactate contents in group A and group B were both close to the preoperative level, and the difference was not statistically significant (P>0.05). 　Conclusion　① The venous resistance of blood flow across the choke vessel is greater than that of the arterial resistance; ② It is helpful to reduce the venous resistance of blood flow across the choke vessel and improve the survival rate of the flap by shortening the unilateral distance of the arterial and venous blood flow across the choke area.

Key words: Choke vessel, 　Arterial resistance, 　Venous resistance, 　Perforator flap

CHENG Sheng, XI Shan-shan, HE Yao-zhi, MEI Jin, DING Mao-chao . The influence of arterial flow resistance and venous flow resistance of the choke area on the survival of perforator flap[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(6): 648-651.

References

[1] 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.
[2] 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.
[3] Chang H, Nobuaki I, Minabe T, et al. Comparison of three different supercharging procedures in a rat skin flap model[J]. Plast Reconstr Surg, 2004, 113(1): 277-283.
[4] 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.
[5] 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.
[6] Talbot SG, Pribaz JJ. First aid for failing flaps[J]. J Reconstr Microsurg, 2010, 26(8): 513-515.
[7] Fujiwara M, Nagata T, Matsushita Y, et al. Delayed distally based sural flap with temporary venous supercharging[J]. Microsurgery, 2013, 33(7): 534-538.
[8] 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.
[9] 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.
[10]Yu YL, Shao YK, Ding YQ, et al. Decellularized kidney scaffold-mediated renal regeneration[J]. Biomaterials, 2014, 35(25): 6822-6828.
[11]楼新法, 梅劲, Mao-lin T, 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.
[12]Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma[J]. N Engl J Med, 1991, 324(1): 1-8.
[13]Frcs GIT, Fracs,, Frcs JHP. The vascular territories (angiosomes) of the body: experimental study and clinical applications[J]. Br J Plast Surg, 1987, 40(2): 113-141.
[14]Gigliofiorito P, Sinziana I, Pendolino AL, et al. True and "choke" anastomoses between perforator angiosomes: part I. Anatomical location[J]. Plast Reconstr Surg, 2013, 132(6): 1447-1456.
[15]Chubb DP, Taylor GI, Ashton MW. True and 'choke' anastomoses between perforator angiosomes: part II. dynamic thermographic identification[J]. Plast Reconstr Surg, 2013, 132(6): 1457-1464.
[16]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.
[17]庄跃宏，胡斯旺，吴东方，等. 一种研究choke 血管新的动物模型—大鼠背部皮窗[J]. 中国临床解剖学杂志, 2011, 29(6): 609-613.
[18]Zhuang Y, Hu S, Wu D, et al. A novel in vivo technique for observations of choke vessels in a rat skin flap model[J]. Plast Reconstr Surg, 2012, 130(2): 308-317.
[19]戴开宇, 胡斯旺, 庄跃宏, 等. 大鼠背部跨区皮瓣的Choke静脉的变化规律[J]. 解剖学报, 2013, 44(2): 238-244.
[20]胡斯旺, 庄跃宏, 崔怀瑞, 等. 大鼠背部穿支体区间choke血管变化规律初探[J]. 中国临床解剖学杂志, 2014, 32(5): 580-584.
[21]胡斯旺, 毛海蛟, 庄跃宏, 等. 再探大鼠背部穿支体区间choke血管变化规律[J]. 中国临床解剖学杂志, 2014, 32(6): 690-693.
[22]Wang Y, Chen SY, Gao WY, et al. Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply[J]. Br J Surg, 2015, 102(4): 375-381.
[23]习珊珊, 丁茂超, 郑俊, 等. 尾静脉注射DMOG对大鼠跨区皮瓣choke血管区的影响[J]. 中华显微外科杂志, 2016, 39(2): 145-149.
[24]李红, 毛以华, 郝晓迪, 等. 外科延迟术对跨区皮瓣多血管体间微循环重构的影响[J]. 解剖学报, 2016, 47(5): 645-651.
[25]庄跃宏, 梁成, 温福利, 等. 延迟术通过加强血管扩张的方式促进跨区皮瓣存活[J]. 中国临床解剖学杂志, 2015, 33(1): 44-50.

The influence of arterial flow resistance and venous flow resistance of the choke area on the survival of perforator flap

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