【作者】 尹刚；

【导师】 贾堂宏；

【作者基本信息】 山东大学 ， 外科学， 2007， 硕士

【摘要】 目的：随着现代工农业的发展，四肢皮肤撕脱伤、热压伤、严重烧伤的病人越来越多，对创面早期、良好覆盖是外科修复的重要研究课题。真皮下血管网皮瓣(SVNF)用于面颈部及手部皮肤缺损、电烧伤、感染创面、皮肤撕脱伤的修复，皮瓣薄形态不臃肿，长宽比例大，愈后色泽好，断蒂早，简单易行，安全可靠。而随意型SVN皮瓣血供范围有一定限度，皮瓣长宽之比不能超出2.5：1的范围，否则皮瓣远端会出现缺血坏死，成活无保证。本实验通过使用碱性成纤维细胞生长因子(bFGF)促进猪随意型真皮下血管网皮瓣远端基底部和边缘部血运，以提高SVN皮瓣成活率，扩大其临床应用范围。方法：本实验以三个月龄健康家猪为动物模型。体重(20±2.5)kg，雌雄不限。(1)动物模型的建立：在每只家猪两侧背部形成6个随意型真皮下血管网皮瓣，切断从腹乳线处发出的轴型血管后形成随意型皮瓣，长16cm，宽4cm。皮瓣的长轴与猪的纵轴垂直。(2)分组：皮瓣形成后按随机分配的原则分为两组，碱性成纤维细胞生长因子组和对照组。碱性成纤维细胞生长因子组：12个随意型真皮下血管网皮瓣(subdermal vascular network flap SVNF)对照组：12个随意型真皮下血管网皮瓣(subdermal vascular network flap SVNF)。(3)影响因素实施：bFGF(购自东大生物工程公司)，SVNF形成后，即刻在皮瓣距蒂部12cm处，14cm处及皮瓣最远端分别选择6个注射点，给予皮下注射，处理如下：碱性成纤维细胞生长因子组：每一位点真皮下层注射含有bFGF的肝素化生理盐水0.1ml，共0.6ml。对照组：每一位点皮下注射0.1ml肝素化生理盐水，共0.6ml。药物注射后，将皮瓣原位缝合，皮瓣远断1／3打包加压包扎。家猪麻醉清醒后，单笼饲养，每日肌肉注射青霉素400万单位预防感染。(4)检测指标大体观察：术后6天将家猪再次全麻后拆除打包线，肉眼观察各组皮瓣颜色，质地及猪毛生长情况，计算出各组皮瓣成活率。组织学观察：分别在各个皮瓣近、中、远1／3处切取1×1×1cm的组织块，光镜下观察组织学变化，计算组织中血管断面的密度。结果碱性成纤维细胞生长因子组和对照组于术后第六天，真皮下血管网皮瓣的成活面积分别为(81.2±1.67)％和(66.21±1.78)％，经统计学检验，实验组和对照组有显著性差异(p＜0.05)。皮瓣近中远段皮瓣血管密度分别为(16.7±6.0)、(29.7±5.5)、(14.9±6.0)／mm~2和(16.6+4.0)、(21.4±5.2)、(3.5+5.1)／mm~2(p＜0.05)。大体观察和组织学观察碱性成纤维细胞生长因子组优于对照组。结论真皮下血管网皮瓣下局部注射碱性成纤维细胞生长因子后，通过促进真皮下血管网皮瓣远端基底部和边缘部的血运，可以提高真皮下血管网皮瓣的成活率，缩短皮瓣的断蒂时间，扩大皮瓣长宽比例。更多还原

【Abstract】 Objective: As China becomes more and more developed, patients suffered from industry and agriculture accident increase. Many traumas incurred by accident including degloving injury, heat pressure injury bum injury etc. Combine with soft tissue defect,especially skin defect,and deep tissue exposure,which need to be covered or reconstructed by flap or free grafts on time. SVNF （Subdermal Vascular Network Flap） is a new member of flap family .The good texture of this flap makes it a best candidate for repairing skin defect on face or limb. where cosmetic need is emphsized. The other characteristics of SVNF include early pedicle division feasibility and safety. But the main limit of SVNF is its ratio of length to width,which can’t be surpassed by 2.5:l,otherwise the distal part wil be necrosis. bFGF is a kind of glycoprotein which can enhance local endothelial cell proliferation vascular hyperpermeability and promote angiogenesis. We want to know if bFGF applied locally can improve the vascular reconstructiono of SVNF and the influence of applying dosage.. methods of bFGF on surrival rate of the flap. Methods Four white healthy pigs were used,weigh （20±2.5）kg , including male and female pigs.（1）the establishment of animal body:each pig had 6 SVNF On back,cut down the blood vessel from the abdomen milk line to form random pattern skin flaps. 16cm×4cm,the long axis of skin flap is vertical with the long axis.（2）Grouping :totally 24flaps were divided randomly into 2 groups. the bFGF groups and the control groups. the group of basic fibroblast growth factor: twelve random pattern subdermal vascular network flaps, the control group: twelve random pattern subdermal vascular network flaps,（3）enforce of the influential factor:bFGF（buy from the DONG DA biological engineering company）,as the SVNF were formed,choose the points that 12cm, 14cm, 16cm from the stem of skin flap as injection points,to give subcutaneous injection. to handle as follows: the bFGF groups:heparinezed saline containing bFGF 0.1ml was injected in every point,0.6ml heparinezed saline containing bFGF was used. the control group: heparinezed saline without bFGF was injected in every point. 0.6ml heparinezed saline was used.After the injection of medication ,suture the skin flap in natural position,the distal 1/3 of the skin flap was packaged and pressured dressing. after the pigs clear-headed from the anaesthesia,every pig was feed in a cage,400 ten thousand penicilin was injected every day to prevent infection.（4）detection index: observation:on the 6^th postoperative day ,we demolish the package to observe the color ,texture and growth of pig hair of every group, to compute the survival rate of every group,histology observation: to take 1×1×1cm tissue from near middle and far 1/3 of every skin flap,to observe the change of histology under light microscope,calculate the density of vessel in the tissue.Result: The results suggest that the injection of bFGF locally can promote the survival rate by accelerating the blood circulation of the SVNF’ bottom and edge. shorten the division time of SVNF and broaden the ratio of length and width.更多还原