Gürünlüoğlu R, Bayramiçli M, Doğan T, Cakalağaoğlu F, Numanoğlu A
Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Ann Plast Surg. 1999 Jul;43(1):42-8. doi: 10.1097/00000637-199907000-00007.
An experimental study was conducted to investigate whether a fascial graft can be used as an interface between a vascular pedicle and target tissue to augment tissue survival in a prefabricated flap. Thirty-six male Sprague-Dawley rats were divided into three experimental groups according to the type of the recipient bed prepared for the vascular implantation. The left saphenous vascular pedicle was used as the vascular source. A 9 x 9-cm inferiorly based peninsular abdominal flap was elevated in each animal. In group I, the pedicle was tacked beneath the abdominal flap, in which the epigastric fascial layer was untouched. In group II, a 3 x 5-cm graft of epigastric fascia was harvested from the abdominal flaps under loupe magnification. The graft was sutured back into its original position after a 180-deg rotation. The vascular pedicle was then implanted just beneath the center of the fascial graft. In group III, the same size of epigastric fascia was removed in the same manner as group II, exposing the subcutaneous layer for pedicle implantation. Four weeks later, abdominal flaps were raised as island flaps connected only to the saphenous pedicle and were sutured in place. Flap viability was assessed visually on day 7. Overall, the ultimate flap survival in group I was the largest, with some necrotic areas at the periphery of the flaps. In group II, flap survival was typically centralized over the fascial graft, and crescent-shaped necrosis was noted superiorly. In group III, an almost linear pattern of survival overlying the vascular pedicle was observed. The mean surviving flap area of group I (12.13 +/- 1.615 cm2) was statistically greater than that of group II (8.83 +/- 0.663 cm2, p < 0.001) and group III (6.3 +/- 0.815 cm2; p < 0.001). There was a statistically significant difference between the mean flap survival in groups II and III (p < 0.001). Vascular arborization was examined by microangiography, and specimens were processed for histological staining. In group II, vascularization was distributed in a larger area along the fascial graft in comparison with limited vascularization around the pedicle in group III. In this study it was revealed that the interposition of a fascial graft as an interface between the vascular source and the target tissue seems to increase the size of the prefabricated flap.
进行了一项实验研究，以调查筋膜移植物是否可作为血管蒂与靶组织之间的界面，来提高预制皮瓣中的组织存活率。36只雄性斯普拉格-道利大鼠根据为血管植入准备的受区床类型分为三个实验组。左隐静脉血管蒂用作血管源。在每只动物身上掀起一个9×9厘米的下蒂半岛状腹部皮瓣。在第一组中，将血管蒂固定在腹部皮瓣下方，其中腹直肌筋膜层未受触动。在第二组中，在放大镜下从腹部皮瓣切取一块3×5厘米的腹直肌筋膜移植物。将移植物旋转180度后缝合回其原始位置。然后将血管蒂植入筋膜移植物中心的正下方。在第三组中，以与第二组相同的方式切除相同大小的腹直肌筋膜，暴露皮下层用于血管蒂植入。四周后，将腹部皮瓣掀起成为仅与隐静脉蒂相连的岛状皮瓣并缝合到位。在第7天通过肉眼评估皮瓣存活率。总体而言，第一组皮瓣最终存活面积最大，皮瓣周边有一些坏死区域。在第二组中，皮瓣存活通常集中在筋膜移植物上方，并且在上方可见新月形坏死。在第三组中，观察到血管蒂上方几乎呈线性的存活模式。第一组皮瓣平均存活面积（12.13±1.615平方厘米）在统计学上大于第二组（8.83±0.663平方厘米，p<0.001）和第三组（6.3±0.815平方厘米；p<0.001）。第二组和第三组皮瓣平均存活面积之间存在统计学显著差异（p<0.001）。通过微血管造影检查血管分支情况，并对标本进行组织学染色处理。与第三组血管蒂周围有限的血管化相比，在第二组中，血管化沿着筋膜移植物分布在更大的区域。在本研究中发现，插入筋膜移植物作为血管源与靶组织之间的界面似乎可增加预制皮瓣的面积。
