Slavin S A, Van den Abbeele A D, Losken A, Swartz M A, Jain R K
Harvard Medical School, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Ann Surg. 1999 Mar;229(3):421-7. doi: 10.1097/00000658-199903000-00017.
The goals of this work were to develop animal models of lymphedema and tissue flap transfer, and to observe physiologic changes in lymphatic function that occur in these models over time, both systemically with lymphoscintigraphy (LS) and locally using fluorescence microlymphangiography (FM).
Although lymphedema has been managed by a combination of medical and surgical approaches, no effective long-term cure exists. Surgical attempts aimed at reconnecting impaired lymphatic channels or bypassing obstructed areas have failed.
The tails of rats (A groups) and mice (B groups) were used because of their different features. Lymphedema was created by ligation of the lymphatics at the tail base and quantified by diameter measurements there. In the experimental group, rectus abdominis myocutaneous flap was transferred across the ligation. In addition to the ligation (A1 and B1) and ligation + flap (A2 and B2) groups, three control groups were included: sham flap with ligation (B4), sham flap alone (B5), and normal (A3 and B3) animals. Observations were made at weekly time points for lymphatic function and continuity.
Lymphedema was successfully created in the mouse ligation groups (B1 and B4) and sustained for the entire length of observation (up to 14 weeks). Lymphatic continuity was restored in those animals with transferred flaps across the ligation site (A2 and B2), as seen both by LS and FM. Sham flaps did not visibly affect lymphatic function nor did they cause any visible swelling in the tail.
Acute lymphedema developing after ligation of tail lymphatics in mice can be prevented by myocutaneous flap transfer. Restored lymphatic continuity and function were demonstrable using lymphoscintigraphy and fluorescence microlymphangiography.
本研究的目的是建立淋巴水肿和组织瓣转移的动物模型，并观察这些模型中随着时间推移淋巴功能发生的生理变化，通过淋巴闪烁造影术（LS）进行全身观察，以及使用荧光显微淋巴管造影术（FM）进行局部观察。
尽管淋巴水肿已通过药物和手术相结合的方法进行治疗，但尚无有效的长期治愈方法。旨在重新连接受损淋巴管或绕过阻塞区域的手术尝试均告失败。
由于大鼠（A组）和小鼠（B组）的特征不同，故使用它们的尾巴。通过在尾巴基部结扎淋巴管来制造淋巴水肿，并通过测量此处的直径进行量化。在实验组中，将腹直肌肌皮瓣转移至结扎部位。除了结扎组（A1和B1）和结扎+瓣组（A2和B2）外，还包括三个对照组：结扎+假瓣组（B4）、单纯假瓣组（B5）以及正常动物组（A3和B3）。每周对淋巴功能和连续性进行观察。
在小鼠结扎组（B1和B4）中成功制造出淋巴水肿，并在整个观察期（长达14周）内持续存在。通过LS和FM均可见，在结扎部位转移了皮瓣的动物（A2和B2）中，淋巴管连续性得以恢复。假瓣对淋巴功能没有明显影响，也未导致尾巴出现任何明显肿胀。
通过肌皮瓣转移可预防小鼠尾巴淋巴管结扎后发生的急性淋巴水肿。使用淋巴闪烁造影术和荧光显微淋巴管造影术可证实淋巴管连续性和功能得以恢复。
