静脉皮瓣早期分叶的实验研究

发布时间：2018-07-24 11:26

【摘要】：目的：在诸于掌指深度瘢痕挛缩等特殊畸形的修复中，常需要分叶皮瓣做材料。由于动脉皮瓣较厚，分叶时易误伤瓣叶内轴血管支，而静脉皮瓣相对较薄，能够直观或通过透照看清主干的分支，可在直观下依血管分支剪裁早期分叶，，在修复复杂畸形中可能有广泛的用途。在众多学者已确认静脉皮瓣能成活的基础上，本课题旨在通过构建未分叶静脉皮瓣、早期分叶但未结扎瓣叶轴血管支静脉皮瓣及早期分叶且结扎轴血管支静脉皮瓣，探索静脉皮瓣分叶的可行性，以期使静脉皮瓣适用于复杂畸形的修复。方法：以新西兰白兔为实验动物，在侧胸背部设计以胸背静脉为蒂的轴型静脉皮瓣，分别制成A组(未分叶静脉皮瓣)、B组(静脉皮瓣早期分叶，未结扎瓣叶轴血管支)和C组(静脉皮瓣早期分叶，结扎轴血管支)三种不同类型的静脉皮瓣。通过观察不同瓣叶的成活面积，HE染色观察各组皮瓣瓣叶的组织病理学改变，透射电镜观察上皮组织超微结构，比较不同瓣叶微血管密度的形态变化过程，从组织解剖学角度初步探讨其可能的影响机制。结果：观察各组瓣叶成活情况，发现A、B、C组瓣叶成活依次降低，除A、B组间之外各组间差异均有显著性意义。组织形态学检查A、B组瓣叶早期细胞结构变性相对较轻，而C组则出现线粒体严重肿胀、变空，细胞质、细胞器消失。术后6天，A、B组瓣叶微血管密度均值接近术前，而C组瓣叶微血管密度变化不大，除A、B组之间外，各组间差异均有显著性意义。结论：1．保护静脉皮瓣瓣叶的轴血管支以维持静脉血供是瓣叶早期赖以存活的必要条件，只要静脉皮瓣瓣叶轴血管支未结扎，静脉供血未中断，瓣叶就可以象整体静脉皮瓣一样成活。 2．静脉皮瓣早期分叶的可行性是存在的。
[Abstract]:Objective: to repair special deformities such as deep scar contracture of metacarpophalangeal finger, lobulated flaps are often used as materials. Because the arterial flap is thicker, it is easy to damage the vascular branch of the inner lobe of the flap by mistake, but the venous flap is relatively thin, which can directly or clearly see the branches of the trunk, and can be cut into the early lobes according to the vascular branches directly. There may be a wide range of applications in repairing complex deformities. On the basis that many scholars have confirmed that the venous flap can survive, the purpose of this study is to construct an unlobed venous flap, an early leafless but unligated leaflet venous flap, and an early lobulated and ligated axial vascular branch flap. To explore the feasibility of venous flap lobulation in order to make the venous flap suitable for the repair of complex deformities. Methods: the axial venous flap pedicled with thoracic dorsal vein was designed in New Zealand white rabbit. The axial venous flap was made into group A (without lobular venous flap) and group B (early lobulation of venous flap). There were three different types of venous flaps in group C and group C (early lobulation and ligation of axial branches of venous flaps). The histopathological changes of different flap leaves were observed by HE staining, the ultrastructure of epithelium was observed by transmission electron microscope, and the morphological changes of microvessel density in different leaves were compared. The possible mechanism of its influence was discussed from the angle of tissue anatomy. Results: the survival rate of leaves in each group was observed and the survival rate of leaves in group A was decreased in turn with the exception of group A and B there was a significant difference in the survival rate of each group. Histomorphologic examination showed that in group A, the early degeneration of cell structure was relatively mild, while in group C, mitochondria became swollen, empty, cytoplasm and organelle disappeared. The mean value of leaf microvessel density in group A was close to that before operation 6 days after operation, but the microvessel density in group C did not change much, except for group A B, there was significant difference between each group. Conclusion 1. Protecting the axial branches of venous flap lobe to maintain venous blood supply is a necessary condition for early survival of venous flap lobe. As long as the axial branch of venous flap lobe is not ligated, the venous blood supply is not interrupted. The lobes can survive like the whole venous flap. 2. The feasibility of early lobulation of venous flap exists.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R322

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