幾何改良切口對窄蒂皮瓣影響的實驗研究及臨床應(yīng)用
發(fā)布時間：2019-04-23 23:32
【摘要】：目的:通過研究不同幾何形狀的皮瓣設(shè)計對皮瓣淤血的影響來分析窄蒂皮瓣成活的機(jī)理,探索防治皮瓣淤血新方法及臨床應(yīng)用。方法:動物實驗部分:16只新西蘭大白兔,制作淤血皮瓣模型。每只大白兔的背部左右兩側(cè)各設(shè)計兩個同等面積不同幾何形狀的淤血型窄蒂皮瓣。將所有皮瓣分成四組,每組16個,分別設(shè)計為圓形、方形、三角形、切緣為鋸齒形的齒輪樣皮瓣,并分別命名為ABCD組,對每組皮瓣進(jìn)行觀察皮瓣顏色、腫脹程度,成活面積、皮瓣組織的HE染色和用ELISA法來檢測其低氧誘導(dǎo)因子-1α(Hypoxia-inducible factor,HIF-1α)在術(shù)后12h、1d、2d、3d、5d、7d的表達(dá)情況。臨床應(yīng)用部分:根據(jù)缺損的部位及大小形狀進(jìn)行相應(yīng)皮瓣設(shè)計。反向設(shè)計皮瓣,對比組織缺損處形狀,于相對隱蔽部位或遠(yuǎn)離創(chuàng)面的健康組織設(shè)計狹長窄蒂皮瓣,用以修復(fù)缺損,適度增加皮瓣切口周長,既將直線切口改為多個"z”字改型切口,將從中間縱行剪開的壓脈帶置于皮瓣下,以作為引流條,皮瓣的受區(qū)與及供區(qū)均給予負(fù)壓封閉引流設(shè)備(VSD)覆蓋,使其能吸出皮瓣周圍下方各腔隙以及組織內(nèi)淤滯的血液,術(shù)后三天拆除負(fù)壓、拔出引流。結(jié)果:動物實驗部分:1、同一時間點,增加切口總長度而改良的皮瓣血管內(nèi)皮細(xì)胞損傷較輕,微血栓量較少。2、在皮瓣長軸長短差距不大的情況下,增加皮瓣切口長度的皮瓣,HIF-1a的表達(dá)較對照瓣少,隨著時間推移,HIF-1a表達(dá)均不斷減少,且ABCD四組下降幅度遞增。3、改良的皮瓣淤血情況隨切口總長的延長而明顯遞減,成活皮瓣的面積遞增。臨床應(yīng)用部分:治療10例,皮瓣部成活,皮瓣質(zhì)地、彈性、色澤良好,效果滿意。結(jié)論:手術(shù)設(shè)計時通過改變皮瓣形狀來增加手術(shù)切口的總長度,并早期增加外力作用,結(jié)合負(fù)壓引流技術(shù),將起到協(xié)同作用,更好地更及時地去除皮瓣瘀滯血液,減少組織細(xì)胞的缺血缺氧,減少微血栓的形成,避免內(nèi)皮細(xì)胞損傷,組織微循環(huán)的不可逆惡化,可利于皮瓣的存活,這將是防治淤血及簡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 偽 (Hypoxia-inducible factor,HIF-1 偽) 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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R622
本文編號：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 偽 (Hypoxia-inducible factor,HIF-1 偽) 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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R622
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 顧玉東;;皮瓣的靜脈危象及其處理[J];中華手外科雜志;1996年03期
2 曹景敏,魯開化,李江;地塞米松減輕皮瓣缺血再灌注損傷的實驗研究[J];中華顯微外科雜志;1998年02期
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