几何改良切口对窄蒂皮瓣影响的实验研究及临床应用
发布时间：2019-04-23 23:32
【摘要】：目的:通过研究不同几何形状的皮瓣设计对皮瓣淤血的影响来分析窄蒂皮瓣成活的机理,探索防治皮瓣淤血新方法及临床应用。方法:动物实验部分:16只新西兰大白兔,制作淤血皮瓣模型。每只大白兔的背部左右两侧各设计两个同等面积不同几何形状的淤血型窄蒂皮瓣。将所有皮瓣分成四组,每组16个,分别设计为圆形、方形、三角形、切缘为锯齿形的齿轮样皮瓣,并分别命名为ABCD组,对每组皮瓣进行观察皮瓣颜色、肿胀程度,成活面积、皮瓣组织的HE染色和用ELISA法来检测其低氧诱导因子-1α(Hypoxia-inducible factor,HIF-1α)在术后12h、1d、2d、3d、5d、7d的表达情况。临床应用部分:根据缺损的部位及大小形状进行相应皮瓣设计。反向设计皮瓣,对比组织缺损处形状,于相对隐蔽部位或远离创面的健康组织设计狭长窄蒂皮瓣,用以修复缺损,适度增加皮瓣切口周长,既将直线切口改为多个"z”字改型切口,将从中间纵行剪开的压脉带置于皮瓣下,以作为引流条,皮瓣的受区与及供区均给予负压封闭引流设备(VSD)覆盖,使其能吸出皮瓣周围下方各腔隙以及组织内淤滞的血液,术后三天拆除负压、拔出引流。结果:动物实验部分:1、同一时间点,增加切口总长度而改良的皮瓣血管内皮细胞损伤较轻,微血栓量较少。2、在皮瓣长轴长短差距不大的情况下,增加皮瓣切口长度的皮瓣,HIF-1a的表达较对照瓣少,随着时间推移,HIF-1a表达均不断减少,且ABCD四组下降幅度递增。3、改良的皮瓣淤血情况随切口总长的延长而明显递减,成活皮瓣的面积递增。临床应用部分:治疗10例,皮瓣部成活,皮瓣质地、弹性、色泽良好,效果满意。结论:手术设计时通过改变皮瓣形状来增加手术切口的总长度,并早期增加外力作用,结合负压引流技术,将起到协同作用,更好地更及时地去除皮瓣瘀滞血液,减少组织细胞的缺血缺氧,减少微血栓的形成,避免内皮细胞损伤,组织微循环的不可逆恶化,可利于皮瓣的存活,这将是防治淤血及简易又行之有效的方法之一。
[Abstract]:Aim: to analyze the survival mechanism of narrow pedicle flap by studying the effect of skin flap design with different geometric shapes on skin flap congestion, and to explore a new method for prevention and treatment of skin flap congestion and its clinical application. Methods: animal experiment part: 16 New Zealand white rabbits were used to make the model of congestion skin flap. Two narrow pedicle flaps with the same area and different geometric shapes were designed on the left and right sides of the back of each large white rabbit. All the flaps were divided into four groups, 16 in each group. The flaps were designed as circular, square, triangular and serrated gear-like flaps, and were named ABCD group respectively. The skin flaps in each group were observed in color, swelling degree and survival area, and the skin flaps in each group were divided into four groups, the skin flaps were divided into four groups: round, square, triangular and serrated. The expression of hypoxia inducible factor-1 伪 (Hypoxia-inducible factor,HIF-1 伪) was detected by HE staining and ELISA method at 12 h, 1 d, 2 d, 3 d, 5 d, 7 d after operation. Clinical application: the skin flap was designed according to the position and shape of the defect. Reverse design skin flap, compare the shape of tissue defect, design narrow and narrow pedicle flap in the relatively hidden part or far away from the wound, which is used to repair the defect and increase the incision circumference of the skin flap moderately. The straight line incision was changed into a number of "z" type modified incisions, and the compression band cut from the middle longitudinal line was placed under the flap as a drainage strip. The receiving and donor areas of the flap were covered by the negative pressure closed drainage equipment (VSD). After 3 days of operation, negative pressure was removed and drainage was pulled out. Results: 1. At the same time point, the vascular endothelial cell damage of the flap improved by increasing the total length of the incision was mild and the amount of microemboli was less. 2, when the long axis of the flap was not significantly different between the length of the flap and the length of the flap, there was no significant difference in the length of the flap. When the incision length was increased, the expression of HIF-1a in the flap was less than that in the control flap. Over time, the expression of HIF-1a decreased continuously, and the decrease of the four groups of ABCD increased. 3. The blood stasis of the modified flap decreased significantly with the extension of the total length of the incision, and the area of the surviving skin flap increased. Clinical application: 10 cases of skin flap survived, skin flap texture, elasticity, good color, satisfactory results. Conclusion: the surgical design can increase the total length of the incision by changing the shape of the flap, and increase the external force in the early stage. Combined with the negative pressure drainage technique, it will play a synergetic role and remove the blood stasis of the skin flap in a better and more timely manner. Reducing ischemia and hypoxia of tissue cells, reducing the formation of microthrombus, avoiding injury of endothelial cells and irreversible deterioration of microcirculation of tissue can benefit the survival of skin flap, which will be one of the simple and effective methods to prevent and cure congestion.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R622
本文编号：2463904
[Abstract]:Aim: to analyze the survival mechanism of narrow pedicle flap by studying the effect of skin flap design with different geometric shapes on skin flap congestion, and to explore a new method for prevention and treatment of skin flap congestion and its clinical application. Methods: animal experiment part: 16 New Zealand white rabbits were used to make the model of congestion skin flap. Two narrow pedicle flaps with the same area and different geometric shapes were designed on the left and right sides of the back of each large white rabbit. All the flaps were divided into four groups, 16 in each group. The flaps were designed as circular, square, triangular and serrated gear-like flaps, and were named ABCD group respectively. The skin flaps in each group were observed in color, swelling degree and survival area, and the skin flaps in each group were divided into four groups, the skin flaps were divided into four groups: round, square, triangular and serrated. The expression of hypoxia inducible factor-1 伪 (Hypoxia-inducible factor,HIF-1 伪) was detected by HE staining and ELISA method at 12 h, 1 d, 2 d, 3 d, 5 d, 7 d after operation. Clinical application: the skin flap was designed according to the position and shape of the defect. Reverse design skin flap, compare the shape of tissue defect, design narrow and narrow pedicle flap in the relatively hidden part or far away from the wound, which is used to repair the defect and increase the incision circumference of the skin flap moderately. The straight line incision was changed into a number of "z" type modified incisions, and the compression band cut from the middle longitudinal line was placed under the flap as a drainage strip. The receiving and donor areas of the flap were covered by the negative pressure closed drainage equipment (VSD). After 3 days of operation, negative pressure was removed and drainage was pulled out. Results: 1. At the same time point, the vascular endothelial cell damage of the flap improved by increasing the total length of the incision was mild and the amount of microemboli was less. 2, when the long axis of the flap was not significantly different between the length of the flap and the length of the flap, there was no significant difference in the length of the flap. When the incision length was increased, the expression of HIF-1a in the flap was less than that in the control flap. Over time, the expression of HIF-1a decreased continuously, and the decrease of the four groups of ABCD increased. 3. The blood stasis of the modified flap decreased significantly with the extension of the total length of the incision, and the area of the surviving skin flap increased. Clinical application: 10 cases of skin flap survived, skin flap texture, elasticity, good color, satisfactory results. Conclusion: the surgical design can increase the total length of the incision by changing the shape of the flap, and increase the external force in the early stage. Combined with the negative pressure drainage technique, it will play a synergetic role and remove the blood stasis of the skin flap in a better and more timely manner. Reducing ischemia and hypoxia of tissue cells, reducing the formation of microthrombus, avoiding injury of endothelial cells and irreversible deterioration of microcirculation of tissue can benefit the survival of skin flap, which will be one of the simple and effective methods to prevent and cure congestion.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R622
【参考文献】
相关期刊论文 前2条
1 顾玉东;;皮瓣的静脉危象及其处理[J];中华手外科杂志;1996年03期
2 曹景敏,鲁开化,李江;地塞米松减轻皮瓣缺血再灌注损伤的实验研究[J];中华显微外科杂志;1998年02期
，本文编号：2463904
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2463904.html
最近更新
教材专著
