【作者】 卢仕良；

【导师】 熊明根；

【作者基本信息】 第一军医大学 ， 整形外科， 2004， 硕士

【摘要】 目的：探讨浅静脉干及其滋养血管在逆行皮瓣早期再血管化过程中所起的作用，明确在逆行皮瓣中完整的浅静脉干及其滋养血管网的存在是否对皮瓣早期血管化进程产生积极影响，从而明确其是否对皮瓣存活有利，为带浅静脉干的逆行皮瓣的临床应用提供理论依据。 方法：1．应用生物体视学原理和技术检测带浅静脉干的逆行皮瓣移植后早期微血管密度量的变化趋势，与不带静脉干逆行皮瓣作对照比较。2．组织切片观察带浅静脉干的逆行皮瓣血管网的生长、重建、分布等情况。3．皮瓣成活研究。4．临床应用研究：分别在掌背、小腿部制作带浅静脉干的逆行皮瓣，修复患部组织缺损10例。 结果：1．证实带浅静脉干的逆行皮瓣移植后早期微血管长度密度和体积密度逐渐增高，量的变化与不带浅静脉干的皮瓣对照比较有显著性差异。2．组织学观察证实从移植后第3天开始实验组皮瓣有较多新生毛细血管，微血管有侧枝发芽，血管间有吻合沟通。5～7天时微血管密度达到高峰，见大量新生毛细血管形成，血管间吻合丰富，管腔内有血液充盈。组织间可见大量炎症细胞浸润。10天显示仍有新生毛细血管，但增长趋势减缓；管腔血液充盈较好，静脉干管腔内有血细胞，无明显血栓形成，组织间炎细胞减少。对照组皮瓣亦有毛细血管增生，血管增生与同期实验组皮瓣相比较不明显，血管网间吻合较少，血管腔内可见微血栓形成，血管充盈较差。组织间炎症细胞浸润情况与实验组皮瓣类似。3．带浅静脉干的逆行皮瓣移植后成活优于不带浅静脉干的逆行皮瓣，成活率平均相差约12个百分点。4．临床应用10例，皮瓣存活良好，仅一例皮瓣有少许表浅坏死，换药后完全愈合。 结论：浅静脉干及其滋养血管网对皮瓣早期再血管化过程具有促进作用，提示在逆行皮瓣中保留浅静脉干对皮瓣存活有利。更多还原

【Abstract】 Objective:To study the effects of superficial venous trunk (SVT) and its norishing vessels on revascularization in reverse-flow random flaps, to make clear picture of the problem whether the existence of SVT and its norishing vessels can improve the revascularization of reverse-flow flaps early in the transplantation so as to supply the theoretical evidences to the clinical applications. Methods:( 1 ) The morphologic changes of micrangium between the reverse-flow random flap with SVT and no SVT in different phase were observed by using optical microscopy, stereological methods. (2) survival study of reverse-flow flaps with SVT and no SVT of pigs.To compare the survival ratio of 2 groups of flaps including SVT and no SVT (3 ) Clinical practice of reverse-flow random flaps. Results:(1) The micrangium density of skin flaps in both of group I and group II had increasing trend after operation of 3 days.After operation of 3,5,7and 10 th day, the micrangium density in group I were much than that in group II .There is significant difference between the group, which is also proved by the optical icroscopy. ( 2 ) The reverse-flow flaps with SVT intact had the better survival ratio. (3) This flap has been used in 10 cases, all of which succeeded and no one failed. Conclusion:the micrangium density of group I is much higher than that in group II , which suggests that SVT and its norishing vessels can promote the revascularization of the flap early in the transplantation, and the clinical application of the flap shows that the SVT can be ofbenefit to the survival of reverse-flow random flap.更多还原