Chang Shi-Min, Gu Yu-Dong, Li Ji-Feng
Department of Hand Surgery, Huashan Hosptial, Fudan University Medical College, Shanghai, People's Republic of China.
Ann Plast Surg. 2003 Aug;51(2):177-81. doi: 10.1097/01.SAP.0000058492.41316.BB.
The mechanism of venous drainage in reverse-flow island flaps was investigated using the saphenous fasciocutaneous flap in New Zealand White rabbits. Ten animals were allocated into two groups of 10 flaps. In group I (left limb), the distal vascular pedicle (one saphenous artery and two venae comitantes) was not disturbed, maintaining the communicating and collateral branches intact. In group II (right limb), it was separated microsurgically from each other for 3 cm. Intravenous pressure was measured at 5, 15, 30, and 60 minutes after tourniquet release. The values of group II at 30 and 60 minutes were significantly lower (p<0.01) than those of group I. Ten days after flap elevation, the mean survival area of group I (95%) and group II (100%) was not significantly different. Histological examination of the vascular pedicle showed the saphenous veins in group II were more dilated than those of group I. These findings suggest that venous retrograde return in reverse-flow island flaps can be achieved more easily through a "direct incompetent valves route" than through a "circuitous communicating and collateral bypass route."
采用新西兰白兔的隐静脉筋膜皮瓣研究反流岛状皮瓣的静脉引流机制。将10只动物分为两组，每组10个皮瓣。在第一组（左下肢）中，远端血管蒂（一条隐动脉和两条伴行静脉）未受干扰，保持交通支和侧支完整。在第二组（右下肢）中，通过显微手术将它们彼此分离3 cm。在松开止血带后5、15、30和60分钟测量静脉压。第二组在30和60分钟时的值显著低于第一组（p<0.01）。皮瓣掀起10天后，第一组（95%）和第二组（100%）的平均存活面积无显著差异。血管蒂的组织学检查显示，第二组的隐静脉比第一组的更扩张。这些发现表明，反流岛状皮瓣的静脉逆行回流通过“直接无功能瓣膜途径”比通过“迂回交通支和侧支旁路途径”更容易实现。
