Chang Shi-Min, Gu Yu-Dong, Li Ji-Feng
Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai, People's Republic of China.
Plast Reconstr Surg. 2005 Jan;115(1):213-8.
A sural veno-neuro-fasciocutaneous flap in the New Zealand White rabbit was developed, and the role of the large subcutaneous lesser saphenous vein was investigated in proximally based versus distally based flaps. Retrograde dye injection showed that the lesser saphenous vein in rabbits has many valves with strong resistance against reflux. Twenty rabbits were randomly allocated into four groups of 10 flaps each. Group I consisted of proximally based flaps with the lesser saphenous vein intact (outflow) in the veno-neuro-adipofascial pedicle. Group II also consisted of proximally based flaps but the lesser saphenous vein was ligated at 1 cm proximal to the pedicle. Group III consisted of distally based flaps with the lesser saphenous vein intact (inflow) in the veno-neuro-adipofascial pedicle. Group IV also consisted of distally based flaps, but the lesser saphenous vein was ligated at 1 cm distal to the pedicle. The results showed that the mean flap survival area in group I (88.8 percent) was statistically higher than that in group II (62.6 percent, p < 0.001), and was higher in group IV (55.5 percent) than in group III (22.7 percent, p < 0.01). However, group II and group IV had no significant difference (p > 0.05). This experiment demonstrated that flap viability is determined by its intrinsic vascularization, both arterial and venous. The large superficial subcutaneous vein has a positive role (venous outflow) in proximally based flaps but a negative role (venous inflow) in distally based flaps. If the effect of the large subcutaneous vein is excluded, distally based flaps are not inherently inferior to proximally based flaps.
在新西兰白兔身上制作了腓肠神经营养血管筋膜皮瓣，并研究了大隐静脉在近端蒂皮瓣和远端蒂皮瓣中的作用。逆行染料注射显示，兔的小隐静脉有许多瓣膜，对反流有很强的抵抗力。20只兔子被随机分为四组，每组10个皮瓣。第一组为近端蒂皮瓣，其静脉神经脂肪筋膜蒂中的小隐静脉完整（流出道）。第二组也为近端蒂皮瓣，但小隐静脉在蒂近端1 cm处结扎。第三组为远端蒂皮瓣，其静脉神经脂肪筋膜蒂中的小隐静脉完整（流入道）。第四组也为远端蒂皮瓣，但小隐静脉在蒂远端1 cm处结扎。结果显示，第一组皮瓣平均存活面积（88.8%）在统计学上高于第二组（62.6%，p<0.001），第四组（55.5%）高于第三组（22.7%，p<0.01）。然而，第二组和第四组之间无显著差异（p>0.05）。本实验表明，皮瓣的存活能力取决于其自身的血管化，包括动脉和静脉。大的皮下浅静脉在近端蒂皮瓣中起积极作用（静脉流出道），而在远端蒂皮瓣中起消极作用（静脉流入道）。如果排除大皮下静脉的影响，远端蒂皮瓣在本质上并不比近端蒂皮瓣差。
