腓肠神经的交感成分及其对腓肠神经营养血管皮瓣血流动力学影响的探查

doi:10.13418/j.issn.1001-165x.2017.01.006

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (1): 25-30.doi: 10.13418/j.issn.1001-165x.2017.01.006

腓肠神经的交感成分及其对腓肠神经营养血管皮瓣血流动力学影响的探查

谢昀¹, 　邹文选¹, 　方芳², 　张琦², 　叶君健¹, 　庄跃宏²

1. 福建医科大学附属第一临床医学院，福州 350005；　2. 福建医科大学神经生物研究所
人体解剖与组织胚胎学系，福州 350108

收稿日期:2016-09-26 出版日期:2017-01-25 发布日期:2017-02-22
通讯作者: 叶君健，教授，主任医师，E-mail：592841794@qq.com；庄跃宏，副教授，E-mail：zhuangyuehong@163.com
作者简介:谢昀（1973-），福建泉州人，副教授，副主任医师，博士，主要从事皮瓣的临床应用解剖，Tel:13313768796, E-mail： xyxlr@126.com
基金资助:
省属高校高校专项基金(JK2014019)；国家自然科学资金(31401023)；福建省高校新世纪优秀人才基金（2016B029）

The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve

XIE Yun¹，ZOU Wen-xuan¹， FANG Fang²， ZHANG Qi²，YE Jun-jian¹，ZHUANG Yue-hong²

1.First Hospital Affiliated to Fujian Medical University, Fuzhou 35005, China; 2. Institute of Neuroscience, Department of Human Anatomy, Histology and Embryology, Fujian Medical University, Fuzhou 350108, China

Received:2016-09-26 Online:2017-01-25 Published:2017-02-22

摘要/Abstract

摘要：

目的　探讨腓肠神经是否有发出交感纤维支配其伴行血管及腓肠神经切段后近端蒂腓肠神经营养血管皮瓣的血流动力学会出现何种相应变化。方法　在探明兔下肢腓肠神经及其伴行血管相应解剖后，取17只白兔，其中2只白兔直接处死，取腓肠神经血管束。其余15只（30侧后肢）随机等分入神经保留组与神经切断组。神经保留组白兔在行皮瓣切取术后，不对腓肠神经进行处理；神经切断组则在皮瓣掀起后将腓肠神经在其起点处切断。在相应时间点处死两组动物，取腓肠神经营养血管束行乙醛酸染色。利用红外热像仪对上述两组皮瓣术后24 h皮瓣的平均温度进行测量。结果　神经切断组术后3、5及7 d 3个时间点腓肠神经内荧光点及其伴行动脉外膜荧光出现高度一致性的下降，组间荧光评分具有显著性差异(F=13.563, P=0.004)。神经保留组在术后整个过程中荧光强度未出现明显改变。术后2 h起，神经保留组皮瓣平均温度低于神经切断组，两者差异具有统计学意义（P＜0.05）。结论　腓肠神经有发出交感纤维至其伴行血管，调节其伴行血管张力。腓肠神经切段后，近端蒂腓肠神经营养血管皮瓣的微循环会出现相应改善，皮瓣存活率有可能增加。

关键词: 交感神经, 腓肠神经, 皮瓣, 红外热像仪, 血液动力学

Abstract:

Objective　To investigate whether the sural nerve emanates sympathetic fibers to its accompanying artery, regulating its tone, and the hemodynamic change of the proximally-based sural neurovascular flap brought about by section of the sural nerve at its origin.　Methods　In 17 rabbits, two rabbits were used as the normal control group, from which the sural neurovascular bundles were harvested without flap creation, and the other 15 rabbits were randomly divided into two groups with 15 sides of hind limbs in each group: a nerve transection group, where the sural nerve was transected at its origin after creation of the proximally-based sural neurovascular flap, and a nerve preservation group, where the sural nerve was untouched after flap creation. The latter two groups were continued to be allocated respectively to three sub-groups according to the time points, i.e., 3d, 5d and 7d after flap creation. The rabbits were executed at the corresponding time points and the sural neurovascular bundles were harvested for glyoxylic acid staining. An infrared thermal imager was used for measurement of the average temperature of the flaps within 24h after flap harvest.　Results　The intensity of green fluorescent staining within the sural nerve and around the tunica externa of the sural artery showed a synchronized gradual decline in the nerve transection group at 3d, 5d and 7d after flap harvest. Significant difference of fluorescent intensity could be detected among the groups (F=13.563, P=0.004). The fluorescent intensity of the sural neurocutaneous bundle showed no decline in the nerve preservation group at the postoperative three time points. The average temperature of the flaps in the nerve transection group was higher than that in the nerve preservation group starting from 2h after flap harvest (P<0.05).　Conclusion　The sural nerve has issued sympathetic fibers to the accompanying arteries, regulating its vascular tone. The microvascular circulation within the proximally-based sural neurocutaneous flap could improve if the sural nerve is divided at its origin, leading to possible increased flap survival.

Key words: Sympathetic fibers, Sural nerve, Flap, Infrared thermal imager, Hemodynamics

谢昀,邹文选,方芳,张琦,叶君健,庄跃宏. 腓肠神经的交感成分及其对腓肠神经营养血管皮瓣血流动力学影响的探查[J]. 中国临床解剖学杂志, 2017, 35(1): 25-30.

XIE Yun，ZOU Wen-xuan， FANG Fang， ZHANG Qi，YE Jun-jian，ZHUANG Yue-hong . The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(1): 25-30.

参考文献

[1] Bertelli JA, Khoury Z. Neurocutaneous island flaps in the hand: anatomic basis and preliminary results [J]. Br J Plast Surg, 1992, 45(8):586-590.
[2] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg [J]. Plast Reconstr Surg, 1992, 89(6):1115-1121.
[3] 钟云祥，钟强，张雄辉，等负压封闭引流联合小腿皮神经皮瓣修复足踝部软组织缺损 [J].临床骨科杂志,2016,19(1)：58-60.
[4] 张世民，徐达传，顾玉东，等.链型皮瓣的血管基础及临床意义[J].中国临床解剖学杂志, 2004, 22(1):13-16.
[5] 高建明，徐达传，王众，等.带蒂股后皮神经营养血管皮瓣的解剖与临床应用 [J]. 中国临床解剖学杂志, 2004, 22(1):26-28.
[6] 吴农欣，徐永清，覃励明，等.足背外侧皮神经营养血管皮瓣的应用解剖学 [J].中国临床解剖学杂志, 2006, 24(2):142-144.
[7] Morgan RF, Reisman NR, Wilgis EF. Anatomic localization of sympathetic nerves in the hand [J]. J Hand Surg Am, 1983, 8(3):283-288.
[8] 杨力，朱小平，郭贤钊，等.腓肠外侧皮神经营养血管皮瓣在小腿组织缺损修复中的应用[J] 重庆医学, 2015, 44(15)：2106-2108.
[9] 曾学文，宋朝辉，李朝阳, 等. 顺行及逆行腓肠神经营养皮瓣的临床应用体会[J]. 中国美容医学杂志，2010，19(10):1427-1429.
[10] 王彦生，沙德峰，田芙蓉，等. 臂内侧皮神经营养血管筋膜皮瓣的临床应用[J]. 中国修复重建外科杂志, 2015, 19(7)：519-520.
[11]谢逸波，李培浩，樊滔，等. 隐神经营养血管皮瓣结合组合外固定架并腿修复对侧小腿创面[J]. 广东医学，2014，35(16)：2566-2567.
[12] de Weerd L， Miland AO，Mercer JB. Perfusion dynamics of free DIEP and SIEA flaps during the first postoperative week monitored with dynamic infrared thermography [J]. Ann Plast Surg, 2009, 62(1): 42-47.
[13] Muntean MV，Strilciuc S，Ardelean F, et al. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators[J].Med Ultrason, 2015, 17(4):503-508.
[14] Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging [J]. Plast Reconstr Surg, 2016, 137(1):39-41.
[15] Just M, Chalopin C, Unger M, et al. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences [J]. Eur Arch Otorhinolaryngol, 2016, 273(9):2659-2667.
[16] de Weerd L, Weum S, Mercer JB. Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge [J].Ann Plast Surg, 2014, 72(2):261.
[17] Mitchell JA. An investigation of an autonomic innervation of the vertebral artery using monoamine histofluorescence [J]. Eur J Histochem, 2004, 48(2):115-120.
[18] Axelsson S, Bjorklund A, Falck B, et al. Glyoxylic acid condensation: a new fluorescence method for the histochemical demonstration of biogenic monoamines [J]. Acta Physiol Scand, 1973, 87(1):57-62.

腓肠神经的交感成分及其对腓肠神经营养血管皮瓣血流动力学影响的探查

The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	乐钦, 陈荣丽, 熊婧熙, 王婷怡, 蔡志恒, 易秋实, 曾心怡. 白芨多糖对大鼠跨区皮瓣choke区的影响[J]. 中国临床解剖学杂志, 2024, 42(1): 59-64.
[2]	吴文斌, 胡雨田, 代琳曦, 吕旺轩, 吕丰均, 尹袁杰, 杨红梦, 畅君达, 李文奇, 郭义威. 椎神经节麻醉的应用解剖学研究[J]. 中国临床解剖学杂志, 2023, 41(6): 640-646.
[3]	徐艺丹, 王燕亭, 陈绍锋, 荆幸, 徐丹, 方芳, 王海, 谢昀, 庄跃宏. 法舒地尔促进小鼠皮瓣术后神经再生的研究[J]. 中国临床解剖学杂志, 2023, 41(4): 447-452.
[4]	宋荷花, 张其, 吴必华, 陈伟, 张天华, 聂开瑜, 常树森, 邓呈亮, 李海, 周健, 李书俊, 魏在荣. IV级穿支血管与网状血管供血皮瓣成活关系的研究[J]. 中国临床解剖学杂志, 2023, 41(3): 288-295.
[5]	何晓清, 杨曦, 石岩, 徐月仙, 方翔, 范新宇, 吴亚玲, 徐永清. 腓肠外侧浅动脉穿支皮瓣术中解剖学观察及临床意义[J]. 中国临床解剖学杂志, 2023, 41(2): 132-136.
[6]	仇玉君, 付裕, 苏航, 尹思源, 王玥清, 唐茂林, 习珊珊. 蒂部动脉位置对跨区穿支皮瓣成活的影响[J]. 中国临床解剖学杂志, 2022, 40(6): 660-664.
[7]	王镱凝, 范新宇, 毕鑫, 彭玉峰, 毕振宇. 腹前外侧壁穿支皮瓣修复下肢大面积组织缺损的临床研究[J]. 中国临床解剖学杂志, 2022, 40(6): 725-729.
[8]	常树森, 何春念, 陈伟, 周健, 张芳, 聂开瑜, 邓呈亮, 魏在荣. 旋股外侧动脉降支Flow-through皮瓣联合MIPPO于急诊胫腓骨Gustilo IIIC型骨折中的应用研究[J]. 中国临床解剖学杂志, 2022, 40(6): 733-737.
[9]	孙钰, 杨利学, 王官林, 朱伟, 仇永锋, 梁浩浩. “泳裤供区”理念下探讨旋髂浅动脉穿支皮瓣修复四肢软组织缺损的临床应用[J]. 中国临床解剖学杂志, 2022, 40(5): 587-591.
[10]	陈绍锋, 荆幸, 方芳, 范莹娟, 庄跃宏. 时间与缺血程度对皮瓣延迟效果的影响探讨[J]. 中国临床解剖学杂志, 2022, 40(4): 447-453.
[11]	吴东方, 刘东红, 方芳, 荆幸, 陈绍锋, 庄跃宏. 大鼠腹壁浅动脉皮瓣游离移植至腋窝模型的构建技巧[J]. 中国临床解剖学杂志, 2022, 40(3): 271-276.
[12]	陈京国, 仇申强, 朱明昇, 郝丽文, 王增涛. 指背多级推进皮瓣的解剖学研究[J]. 中国临床解剖学杂志, 2022, 40(2): 121-125.
[13]	郭礼平, 巨积辉, 周荣, 王健, 余新水. 3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的效果研究[J]. 中国临床解剖学杂志, 2022, 40(2): 221-224.
[14]	刘学贵, 杨俊贵. 改良动脉化游离静脉皮瓣临床应用研究[J]. 中国临床解剖学杂志, 2022, 40(2): 225-227.
[15]	李书俊, 　常树森, 　王达利, 　金文虎, 　孙广峰, 　魏在荣. 递进皮下蒂双V-Y皮瓣联合甲床扩大术修复甲床指端缺损[J]. 中国临床解剖学杂志, 2022, 40(1): 78-80.