【作者】 刘强；

【导师】 赵天兰；

【作者基本信息】 苏州大学 ， 整形外科学， 2010， 硕士

【摘要】 目的:通过在猪背部设计不同长宽比例的狭长窄蒂任意型皮瓣,测定各组皮瓣内一氧化氮合酶(nitric oxide synthase,NOS)和CD34的表达量并观察皮瓣的成活面积,揭示NOS、CD34表达量与皮瓣成活的关系,以探讨狭长窄蒂皮瓣的成活机理。方法:在5只白色实验猪的两侧背部分别形成蒂部宽长比为2cm:4cm的狭长窄蒂皮瓣各5个,5个皮瓣携带不同面积的任意皮瓣,分别为2cm×2cm、3cm×3cm、4cm×4cm、5cm×5cm、6cm×6cm,并依次命名为A、B、C、D、E,瓣与瓣间距4cm,蒂部距背部中线4cm,顺序随机排列。皮瓣形成后即刻经耳缘静脉推注10%荧光色素钠25mg/kg,10分钟后在紫外线灯下观察皮瓣荧光染色范围,预测皮瓣成活面积;术后对每组皮瓣进行大体观察、术中即刻、术后3、5、7、14天各取皮瓣远端外缘约0.5cm×0.3cm全厚皮肤组织块分装保存,进行病理学观察、免疫组化染色、准确称重后按重量体积比1:9制备成10%的组织匀浆,取上清测定皮瓣内NOS、CD34表达量,术后14天计算皮瓣存活面积,观察NOS、CD34在皮瓣愈合过程中的动态变化及其在不同面积窄蒂皮瓣中表达量的区别,揭示NOS、CD34表达量与皮瓣存活的关系。结果:突破传统长宽比例限制的狭长窄蒂任意型皮瓣存活良好,其中A、B、C组皮瓣NOS、CD34的表达量随着皮瓣面积的增大逐渐升高,皮瓣完全存活(P<0.05);D、E组皮瓣当皮瓣面积达到一定限度时NOS、CD34表达量不再随着皮瓣面积的增大而无限升高,表达相对恒定,皮瓣远端部分坏死(P>0.05)。各组中NOS、CD34的表达量术后逐渐升高,其中NOS在术后第5天达到高峰,5-7天维持在高水平,以后逐渐下降;CD34在术后逐渐上升,术后第5天达到高峰,5-14天一直维持在高水平。结论:1、任意型皮瓣的成活与蒂宽没有直接比例关系,蒂长宽比固定时一定范围内皮瓣面积逐渐增大时,皮瓣成活良好;当皮瓣面积达到一定限度后,再增大皮瓣面积,皮瓣成活面积到达最大值,超出部分远端将会坏死。2、一定范围内,随着皮瓣面积的增大,皮瓣中NOS、CD34的表达量也逐渐升高,皮瓣完全成活;超过一定范围后,再增大皮瓣面积,NOS、CD34表达量达最大值,不再升高,皮瓣远端部分坏死。3、任意型皮瓣中NOS、CD34表达量与皮瓣成活具有明显相关性。更多还原

【Abstract】 Objective: To design different long and narrow aspect ratio of narrow pedicle flaps in pigs back, we measured the expression of NOS and CD34 in different time, observed the survival area of shin flaps. We tired to reveal the relationship between NOS、CD34 expression and the flap survival area, explored the narrow strip of flap survival mechanism.Methods: The five white domestic pigs were formed five narrow flaps on both sides of the back, which pedicle width length ratio were 2cm:4cm strip, five flap carried different areas of random skin flap, respectively 2cm×2cm, 3cm×3cm, 4cm×4cm, 5cm×5cm, 6cm×6cm, and in turn named A, B, C, D, E. Flaps and flaps spaced 4cm, the pedicle back were away from the midline 4cm. All flaps were randomly arranged. After the operation, we injected 10% of the fluorescent pigment sodium (25mg/kg) into pigs through the ear vein. 10 minutes later, we observed the range of flaps fluorescence staining and predicted flap survival area under the UV lamp. Surgery in the immediate postoperative, the 3rd, the 5th,the 7th,the 14th day, we cut 0.5cm×0.3cm full - thickness tissue from each flaps of the outer edge to carry out pathological examination, immunohis-tochemical staining and determined NOS, CD34 expression. After 14 days, we measured flap survival area, observed contents of NOS, CD34 in flaps healing process, comprehended their dynamic change, in order to reveal the relationship between expression of NOS, CD34 and flap survival rate.Results: Narrow pedicle flaps survived well, which broke out traditional restrictions on the narrow aspect ratio. For A, B, C group flaps, expression level of NOS, CD34 increased as the flap gradually increased, flaps completely survived(P<0.05); For D, E group flaps, expression level of NOS, CD34 no longer increased with the increase of skin flap area , while its expression were constant relatively, flap partial necrosis(P>0.05). Each group in the NOS, CD34 expression level gradually increased after operation, in which NOS got to peak in the 5th day, the 5th-7th days were maintained at a high level, and then gradually decreased; CD34 gradually increased after the operation, and got to peak in the 5th day, the 5th day to the 14th day had been maintained at high levels.Conclusions: 1.Aspect ratio is not the crucial factor which determine flaps survive or not, aspect ratio and survival area are not directly proportion relationship; within a certain aspect ratio, area increases, flaps survive well; When flaps reach a certain level, then increase flaps area, flap survival area reach to the maximum, the excess will be remote necrosis. 2.Within a certain range, with the flap area increase, flaps NOS,CD34 expression level gradually increase, flaps survive completely; more than a certain range, and increase flaps area, flaps NOS,CD34 expression will be permanent, some flap will necrosis; 3.The expression of NOS, CD34 in Random pattern flap and flap survival rate have obvious relevance.更多还原