Angel M F, Knight K R, Dvir E, Mellow C G, Morrison W A, O'Brien B M
Johns Hopkins School of Medicine, Baltimore, Maryland 21205.
J Surg Res. 1992 Jul;53(1):24-9. doi: 10.1016/0022-4804(92)90008-n.
There has been great interest stimulated by reports on factors influencing the survival of skin flaps which possess only venous inflow and outflow, i.e., venous flaps. The present study serially (Days 1, 2, and 4 postoperatively) observed several biochemical factors which might affect flap survival. ATP levels were measured to assess endogenous energy stores, malonyldialdehyde (MDA) and xanthine oxidase (XO) to estimate free radical production, superoxide dismutase (SOD) to quantify antioxidant defenses, and edema to measure inflammatory changes. Eighteen thighs on nine dogs were assigned randomly to one of three groups: full-thickness skin grafts, flaps based solely on the saphenous artery and vein (AV flaps), or flaps based solely on the saphenous vein (venous flaps). These were regarded as being mostly ischemic, totally perfused, and partially ischemic, respectively. Control skin biopsies were obtained adjacent to surgical sites. AV flaps and control skin were similar in all respects. Venous flaps compared with skin grafts were significantly less edematous (P less than 0.01) had less MDA and XO (P less than 0.05), but no significant differences in SOD and ATP levels. However venous flaps had significantly less ATP than AV flaps (P less than 0.01). Thus venous flaps survive despite depletion of ATP levels. These results suggest that decreased free radical production and lessened edema may be important factors in promoting ultimate survival of venous flaps.
关于影响仅具有静脉流入和流出的皮瓣（即静脉皮瓣）存活因素的报道引发了极大的关注。本研究在术后第1天、第2天和第4天连续观察了几种可能影响皮瓣存活的生化因素。测量ATP水平以评估内源性能量储备，测量丙二醛（MDA）和黄嘌呤氧化酶（XO）以估计自由基产生，测量超氧化物歧化酶（SOD）以量化抗氧化防御，并测量水肿以衡量炎症变化。将9只狗的18条大腿随机分为三组之一：全厚皮片、仅基于隐动脉和静脉的皮瓣（AV皮瓣）或仅基于隐静脉的皮瓣（静脉皮瓣）。这些分别被视为大部分缺血、完全灌注和部分缺血。在手术部位附近获取对照皮肤活检样本。AV皮瓣和对照皮肤在所有方面都相似。与皮片相比，静脉皮瓣水肿明显较轻（P小于0.01），MDA和XO较少（P小于0.05），但SOD和ATP水平无显著差异。然而，静脉皮瓣的ATP明显低于AV皮瓣（P小于0.01）。因此，尽管ATP水平耗尽，静脉皮瓣仍能存活。这些结果表明，自由基产生减少和水肿减轻可能是促进静脉皮瓣最终存活的重要因素。
