摘要
目的研究负压引流对扩张皮瓣血液循环的影响，以指导临床在耳廓再造中合理有效使用负压引流技术。方法将21例耳廓再造患者随机分为A、B、C3组，分别给予-20、-40和-60kPa负压引流，并于术后即刻、5和10d分别测量计算3组患者再造耳廓的长、宽之差值，以间接了解再造耳廓肿胀和皮瓣静脉回流情况。术后采用红外热像仪检测再造耳廓于0、-20、-40和-60kPa负压下皮瓣近（耳甲腔）、远端（耳轮缘）的温度变化。结果B组术后5d再造耳廓的长、宽差值分别为（1．48±0．47）mm和（0．36±0．06）mm，明显小于术后即刻的（1．67±0．69）mm和（0．40±0．16）mm；A、c组也有差别，但并无统计学意义（P〉0．05）。B组术后10d再造耳廓的长、宽差值分别为（1．31±0．42）mm和（0．48±0．04）mm，与术后5d比较，差异有统计学意义（P〈0．01）；而A、C2组比较，差异无统计学意义。再造耳廓皮瓣肿胀程度随负压值增大，呈现先下降后增加的趋势〈P〈0．01）；扩张器自体肋软骨耳廓再造术负压引流强度在0～60kPa范围内，随负压强度增大，再造耳廓皮瓣温度升高（P〈0．01）；且近端温度的增加大于远端，差异有统计学意义（P〈0．01）。结论负压引流对再造耳廓皮瓣静脉回流及动脉供血均有影响，-40kPa负压对再造耳廓动脉供血及静脉回流均有促进作用，可为临床设定负压引流强度提供参考。
Objective To investigate the effect of vaccum drainage on blood circulation of expanded skin flap, so as to confirm suitable negative pressure for ear reconstruction. Methods 21 patients （Auricular Reconstructive Center of Plastic Surgery Hospital, PUMC） were randomly divided into A, B, C 3 groups to receive vaccum drainage of： -20, -40 and -60 kPa, respectively. The length and width of reconstructed ears,which represented the swelling degree, were measured instantly and 5, 10 days postoperatively. The changes were calculated and reflected venous drainage of flaps. The temperature of proximal （concha） and distal （helix） part of the expanded flaps, which represented the arterial blood supply of flaps, was detected by infrared thermography after operation. Results Five days after operation [（1.48±0.47） mm, （0.36±0.06） mm] and immediately[（1.67±0.69） mm,（0.40±0. 16） mm） ] , the changes of the length and width of reconstructed ear in group B was significantly low, while there was no statistically difference between group A and C （P 〉 0.05 ）. The data between 10 days and 5 days after operation showed the same result. Along with the increase of the negative pressure, the swelling degree of reconstructed ears decreased firstly and then increased reversely （P 〈 0.01 ）. The flap temperature of reconstructed ears in creased（ P 〈0.01 ） , especially in proximal（concha） part（ P 〈0.01） ,when the negative pressure increased （0 to -60 kPa）. Conclusions Vacuum drainage has effect on both the venous drainage and blood supply. Negative pressure of -40 kPa can improve both the blood supply and venous drainage. It should be as reference for clinical application.
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2013年第4期254-257,共4页
Chinese Journal of Plastic Surgery
基金
国家自然科学基金（81071113）
十二五国家科技支撑计划（2012BAll2801）
关键词
外科皮瓣
耳廓再造术
负压引流技术
Surgical flaps
Auricular reconstruction
Vacuum drainage
