目的 比较多部位皮肤IV级穿支血管网分布情况，探讨IV级穿支血管与网状供血皮瓣成活的关系。 方法 健康成年SD大鼠18只，体重200~250 g，雌雄不限，随机数字表法分为正常皮肤组（对照组）、腹部两侧网状血管供血皮瓣组、背部两侧网状血管供血皮瓣组，每组6只。采用网状血管供血皮瓣制作方法造模。同时收集本院烧伤整形外科因皮肤缺损行头面部、大腿内外侧、小腿内外侧皮瓣转移的患者供区缝合时形成的“猫耳”畸形多余皮肤组织。大鼠术后第7天运用Image J软件计算皮瓣成活率，取大鼠各组皮肤组织和患者供区多余皮肤软组织，采用HE染色、CD31免疫组化染色比较IV级穿支血管密度、直径情况。 结果 大鼠术后第7天背部网状供血皮瓣成活率较腹部网状血管供血皮瓣高（P<0.05）；正常组背部皮肤中IV级穿支血管密度较腹部皮肤高（P<0.05），直径无显著差异（P>0.05）；术后7 d腹、背部皮瓣组远端IV级穿支血管直径较近端明显减小（P<0.05）、密度较近端明显增大（P<0.05）。人体IV级穿支血管直径比较：头部>大腿内侧、大腿外侧、小腿内侧，小腿外侧>小腿内侧，差异有统计学意义（P<0.05），大腿外侧较内侧大，差异无统计学意义；血管密度比较：头部>大腿内外侧、小腿内外侧，大腿外侧>大腿内侧，小腿外侧>小腿内侧，差异有统计学意义（P<0.05）。 结论 全身各部位皮肤组织IV级穿支血管分布不同，IV级穿支血管密度对于皮瓣成活有重要意义。网状血管供血皮瓣成活的长宽比例与该处皮肤真皮下血管网密度或/和血管直径相关。
Abstract
Objective To investigate the relationship between the perforating vessels of grade IV perforators and the survival of reticular blood-supplying flap, and to compare the distribution of grade IV perforating vascular network in multi-site skin tissue of the whole human body. Methods Eighteen healthy adult SD rats, weighing 200~250 g, were not restricted to males and females. They were divided into a normal skin group (control group), a reticular blood supply flap group on both sides of the abdomen, and a reticular blood supply flap group on both sides of the back. There were 6 flaps in each group. The model was made by using the method of making blood-supply skin flaps with reticular blood vessels. At the same time, the excess skin tissue of the "cat ear" deformity formed during suture of donor site of patients with skin defects of head and face, inner and outer thighs and the inner and outer leg were collected in our hospital. On the 7th day after operation of the rat, the survival rate of the skin flap was calculated by using Image J software. The skin tissues of each group of rats and the excess skin tissues of the patient′s donor area were taken. HE and CD31 staining were used to compare the density of IV perforator blood vessels and diameter situation. Results On the 7th day after operation, the survival rate of the back reticular blood supply flap was higher than that of the abdominal reticular blood supply flap (P<0.05). The density of grade IV perforator blood vessels in the back skin of the normal group was higher than that in the abdominal skin (P<0.05), but there was no significant difference in diameter (P>0.05). The diameter of the distal grade IV perforating vessels was significantly decreased compared with the proximal end in the abdominal and back flap group (P<0.05), while the density was significantly increased compared with the proximal end (P<0.05). Comparison of the diameters of grade IV perforator vessels: head > inner thigh, outer thigh, inner calf, outer calf > inner calf, the difference was statistically significant (P<0.05), the outer thigh was larger than the inner thigh, the difference was not statistically significant. Comparison of blood vessel density: head > inner and outer thigh, inner and outer calf, outer thigh> inner thigh, outer calf> inner calf, the difference was statistically significant (P<0.05). Conclusions The distribution of grade IV perforating vessels is different in different parts of the whole body. The density of grade IV perforating vessels is of great significance for the survival of skin flap. The ratio of length to width of the reticular vascular flap is related to the density of subdermal vascular network and / or the diameter of blood vessels.
关键词
穿支皮瓣 /
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网状血管皮瓣 /
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IV级穿支
Key words
Perforator flap /
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Reticular vascular flap /
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Grade IV perforator
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基金
贵州省创面外科整合治疗科技创新人才团队（黔科合平台人才[2020]5012）
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