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

Abstract

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

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.

References

[1] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle [J].Br J Plast Surg, 1989, 42(6): 645-648.
[2] Hallock GG. Lower extremity muscle perforator flaps for lower extremity reconstruction [J]. Plast Reconstr Surg, 2004, 114(5): 1123-1130.
[3] Galanis C, Nguyen P, Koh J, et al. Microvascular lifeboats: a stepwise approach to intraoperative venous congestion in DIEP flap breast reconstruction [J]. Plast Reconstr Surg, 2014, 134(1): 20-27.
[4] Wei JW, Ni JD, Dong ZG, et al. Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg, ankle, and foot: comparison between pediatric and adult patients [J]. J Reconstr Microsurg, 2014, 30(4): 249-254.
[5] 高建明，郭峰，刘云鹏，等.小腿皮神经营养血管筋膜皮瓣的临床应用[J]. 中国临床解剖学杂志，2008，26(4):446-450.
[6] Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design [J]. Plast Reconstr Surg, 2007, 119(2): 590-598.
[7] Mesic H, Kirkeboen KA, and Bains R. The importance of a skin bridge in peripheral tissueperfusion in perforator flaps [J]. Plast Reconstr Surg, 2012, 129(3): 428e-434e.
[8] 薛兰，吴志海，汤莹莹，等. 激光多普勒对大鼠背部3种皮瓣模型的血流动力学特点研究[J]. 中国临床解剖学杂志，2016，34(1):6-11.
[9] Chang SM, Wang X, Huang YG, et al. Distally based perforator propeller sural flap for footand ankle reconstruction: a modified flap dissection technique [J]. Ann Plast Surg, 2014, 72(3):340-345.
[10]Park SO, Ahn KC, Hong KY, et al. External jugular veno-accompanying artery adipofascial flap: A novel and convenient flap for head and neck reconstruction[J]. Head Neck, 2017, 39(11):2249-2255.
[11]Zhuang YH, Zheng HP, Lin SQ, et al. Vasculature at the medial aspect of the foot and clinicalapplication of flaps based on it for forefoot reconstruction[J]. Plast Reconstr Surg, 2011, 127(5):1967-1978.
[12]Mehrotra S. Perforator-plus concept: adding versatility to traditional flaps [J]. Plast Reconstr Surg, 2009, 123(6): 219e-220e.
[13]Pafitanis G, Raveendran M, Myers S, et al. Flowmetry evolution in microvascular surgery: Asystematic review[J]. J Plast Reconstr Aesthet Surg, 2017, 70(9): 1242-1251.
[14]刘旭东，曾炳芳. 激光多普勒血流监测仪的原理及应用[J]. 中国医疗器械信息，2007，11(2):22-23.
[15]杨小杰. 激光多普勒血流仪在微循环实验和教学中的应用[J]. 中国现代药物应用，2013，7(9):188-189.
[16]Niranjan NS, Price RD, and Govilkar P. Fascial feeder and perforator-based V-Y advancementflaps in the reconstruction of lower limb defects[J]. Br J Plast Surg, 2000, 53(8): 679-689.
[17]Tao Y, Ding M, Wang A, et al. Basic perforator flap hemodynamic mathematical model[J]. Plast Reconstr Surg Glob Open, 2016, 4: e714.
[18] Zhuang Y, Xie Y, Wu Z, et al. Hemodynamic study of three patterns of flaps on rats with a novel panoramic photographing technique involved[J]. Plast Reconstr Surg, 2016, 138(4): 653e-665e.
[19]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.
[20]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.

The role of skin base in perforator-plus flap survival

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Jiang Jianhong, Duan Renpeng, Li Xiaofeng. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 1-4.
[2]	Guo Hongzhi, Wang Yu, Zhang Jiaqi, Liang Haibin, Ma Ziwei, Feng Wei, Wu You, Si Ziyi. Evaluation of placental vascular structure in preeclampsia by vascular casting combined with CT three-dimensional model [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 5-10.
[3]	Li Jiawei, Zhang Jing, Li Canran, Lan Wenjie, Ji Qingyu, Guo Zhiyong, Zhang Yunfeng, Liu Qi, Chen Qingwei, Li Xiaohe. X-ray measurement of proximal femur anatomical parameters in Mongolian population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 11-16.
[4]	. Digital measurement and clinical significance of occipitocervical Angle and posterior occipitocervical Angle in children and adolescents [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 17-20.
[5]	Li Wen, Yang Siyi, Huang Lei, Qing Jiwen, Jiang Songtao, Zhang Lei. Morphological characteristics and clinical significance of Lisfranc ligament based on MRI [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 21-25.
[6]	Li Fanfan, Xu Yang, Wang Xiaoxu. Therapeutic effect of shikonin on the treatment of granuloma lobular mastitis in model rats by regulating Nrf2/HO-1 signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 26-32.
[7]	Wang Xinghang, Ding Jiayuan, Li Fang, Bao Cuifen, Yan Lijing. Ginsenoside Rg1 reduces the inflammatory response of microglia after oxygen glucose deprivation/resupply by inhibiting the NLRP3 inflammasome pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 33-41.
[8]	Cheng Yingying, Wu Jianjun, Cai Haiyan , Jiao Xunwen, Ma Jiangbo, Ding Yinxiu. Activation and functional changes of astrocytes cultured in vitro under inflammatory stimulation [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 42-46.
[9]	Qi Zhi, Yang Li, Jia Qiuye, Chen Haolun, Duan Zhaoda, Wu Chunyun. Edaravone regulates Sirt3 expression in lipopolysaccharide-activated microglia via MAPKs signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 47-53.
[10]	Zhang Jingjing, Wang Hongxin. Protective effect of Baicalin on rats with pulmonary hypertension through PDGF/P38 MAPK signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 54-58.
[11]	Yue Qin, Chen Rongli, Xiong Jingxi, Wang Tingyi, Cai Zhiheng, Yi Qiushi, Zeng Xinyi. Effect of Bletilla striata polysaccharides on the choke-area of cross-boundary flap in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 59-64.
[12]	Li Xiaoyu , Zhang Lei , Fu Lei , Li Dongbo , Wang Guoyou. Finite element study on the treatment of Sanders type II calcaneal fracture with three-step reduction method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 65-70.
[13]	Wu Yanfei, Ma Jianxiong, Lu Bin, Wang Ying, Bai Haohao, Jin Hongzhen, Ma Xinlong. Study on the correlation between the reconstruction of grayscale values using CT post-processing technology and the compressive strength of the endplate [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 71-76.
[14]	Zhuang Wanqiang, Tang Yi, Luo Yonggang, Zhang Hui. An early and mid-term retrospective study of the effects of arthroscopy combined with high tibial osteotomy on patellar position and patellofemoral joint function [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 77-82.
[15]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.