摘要
目的探讨跨区皮瓣远端皮下羊膜包埋对其成活的影响。方法2016年2月至2016年12月，38只SD大鼠随机分为实验组和对照组，每组19只。在大鼠背部正中线的右侧．切取以髂腰动脉为蒂．跨越两个choke血管区、大小为3cm×10cm的跨区皮瓣。实验组在皮瓣远端皮下包埋羊膜后原位缝合．对照组直接原位缝合。每组3只SD大鼠，分别在术前、术后1d、3d、7d连续监测穿支蒂部血流。每组9只SD大鼠分别在术前、术后3d、7d，在ChokeⅡ区取材，HE染色光镜下观察动、静脉形态，并计算两组管径大小改变的相对值。每组7只SD大鼠，术后7d时测量皮瓣成活面积。同时，每组取其中3只．行明胶-氧化铅造影观察皮瓣血管形态。结果实验组和对照组术后7d的成活率分别为（89．09±4．23）％和（74．56±5．59）％．实验组显著高于对照组（t=5．48，P=0．00）。X线片显示，术后7d实验组蒂部髂腰动脉比对照组粗、实验组ChokeⅡ区血管管径比对照组粗。皮瓣血管蒂部血流检测显示，术后1d、3d，实验组血流量高于对照组（t值分别为2．39、3．06；P值分别为0．03、0．00）。HE染色显示，实验组和对照组ChokeⅡ区动、静脉管径在术后3d、7d逐渐增加，实验组管径扩大倍数高于对照组（t值分别为：3．52、3．50；P值分别为0．02、0．02）。结论羊膜皮下包埋可能通过提高皮瓣血管蒂部血流，扩大chokeⅡ区微血管管径来改善皮瓣微循环，促进跨区皮瓣成活，但其具体机制仍有待进一步探讨。
Objective To investigate the effects of human amniotic membrane on the survival of the crossboundary perforator flap in rats through distal subcutaneous implantation. Methods From February, 2016 to December, 2016, 38 SD rats weighing 270-300 g were randomly divided into experimental group and control group （n= 19）. A three-territory perforator flap（3 cm^10 cm） with the iliac artery as the pedicel elevated on the right dorsum of the rats. Experiment group, a section of amnion was sutured to the distal subcutaneous of the flap and then the flap was sutured back to its donor site. Control group, after the flap elevated, directly sutured back to its donor site. The blood flow of the pedicel were detected by laser Doppler flowmetry at the day before surgery, 1 day after surgery, 3 and 7 days after surgery, with 3 rats in every group. When the rats were anesthetized, biopsies were taken from the choke area Ⅱ at the day before surgery, 3 and 7 days after surgery, with 9 rats in every group. When the rats were anesthetized, HE was used to compare the diameter size of the artery and vein at the same site. At day 7, measure the survival area of the flap, and 3 of them observe the vessel of the flap by lead oxide-gelatine technique. Results The survival rate of the experimental group and the control group after 7 days were （89.09±4.23）% and （74.56±5.59）% respectively, the experimental group was significantly higher than that of the control group （t=5.48, P=0.00）. X-ray showed that 7 days after operation, the pedicel of ihac artery in the experimental group was bigger than that in the control group. The blood flow detection showed that the blood flow of the experimental group was higher than that of the control group （t=2.39, 3.06; P=0.03, 0.00, respectively） at day 1 and day 3 after surgery. Hematoxylin eosin staining showed that arteriovenous tube diameter at the Choke Ⅱ were gradually increased on the day3 and day7 after surgery in both group, but the experimental group diameter expanded multiple was higher than that of control group （t=3.52, 3.50; P= 0.02, 0.02, respectively）. Conclusion Human Amnion subcutaneous embedding may improve the blood flow of the vascular pedicle, expand the microvascular at Choke area Ⅱ, improve microcirculation, as a result to promote the survival of cross perforator flap, while the mechanism is needed to understanding.
出处
《中华显微外科杂志》
CSCD
北大核心
2017年第4期358-361,共4页
Chinese Journal of Microsurgery
基金
国家自然基金（81472104）
浙江省教育厅项目（Y201636877）
温州市科技局计划项目（Y20140001,Y20140565）
温州医科大学本专科学生科研立项课题（wyx2015101108）
关键词
人羊膜
皮瓣
Choke区
血管体
大鼠
Human Amnion
Perforator flap
Choke area
Vascular territory
Rat
