在兔皮瓣模型中监测部分和完全静脉流出道受阻情况。
Monitoring partial and full venous outflow compromise in a rabbit skin flap model.
作者信息
Gimbel Michael L, Rollins Mark D, Fukaya Eri, Hopf Harriet W
机构信息
Pittsburgh, Pa.; San Francisco, Calif.; Tokyo, Japan; and Salt Lake City, Utah From the University of Pittsburgh; the University of California, San Francisco; Tokyo Women's Medical University; and the University of Utah.
出版信息
Plast Reconstr Surg. 2009 Sep;124(3):796-803. doi: 10.1097/PRS.0b013e3181b03768.
BACKGROUND
Free flap failure often results from venous thrombosis. The authors developed a rabbit flap model of partial venous obstruction and evaluated four monitoring devices in detecting partial and full venous compromise.
METHODS
Nine skin flaps were elevated on their arteriovenous pedicles in rabbits. The flap was assessed with quantitative Doppler of arterial inflow, transcutaneous oxygen and carbon dioxide tension, near-infrared spectroscopy tissue oxygen saturation, and scanning laser Doppler imaging. After a stable baseline was achieved, the outflow vein was subjected to partial and full venous obstruction followed by release.
RESULTS
Pedicle arterial flow decreased significantly from baseline (5.9 +/- 3.0 ml/minute) during partial (4.1 +/- 2.4 ml/minute; 30.5 percent; p < 0.01) and full obstruction (0.3 +/- 0.4 ml/minute; 94.9 percent; p < 0.01). All other measures changed significantly with full obstruction: transcutaneous oxygen tension decreased by 79.6 percent; transcutaneous carbon dioxide tension increased by 69.0 percent; near-infrared spectroscopy tissue oxygen saturation decreased by 35.7 percent; and scanning laser Doppler imaging decreased by 78.8 percent. Laser Doppler imaging was the only noninvasive device that decreased significantly (p < 0.01) with partial obstruction, from 222.8 +/- 77.3 units to 186.5 +/- 73.2 units (16.3 percent).
CONCLUSIONS
The authors established a venous obstruction flap model and evaluated four clinically relevant monitoring devices during partial and full venous occlusion. All devices detected full occlusion, but only scanning laser Doppler imaging and arterial Doppler detected partial occlusion. Scanning laser Doppler imaging monitoring may allow warning of impending venous obstruction. Near-infrared spectroscopy tissue oxygen saturation varied the least between flaps and therefore may be the most easily interpreted device for full venous occlusion. Both characteristics are important for clinical application.
背景
游离皮瓣失败常因静脉血栓形成所致。作者建立了兔皮瓣部分静脉阻塞模型，并评估了四种监测设备在检测部分和完全静脉受损方面的情况。
方法
在兔身上以动静脉蒂掀起9个皮瓣。用动脉血流定量多普勒、经皮氧和二氧化碳张力、近红外光谱组织氧饱和度及扫描激光多普勒成像对皮瓣进行评估。在达到稳定的基线后，对流出静脉进行部分和完全静脉阻塞，随后解除阻塞。
结果
在部分阻塞（4.1±2.4 ml/分钟；30.5%；p<0.01）和完全阻塞（0.3±0.4 ml/分钟；94.9%；p<0.01）期间，蒂部动脉血流较基线（5.9±3.0 ml/分钟）显著减少。完全阻塞时所有其他指标均有显著变化：经皮氧张力下降79.6%；经皮二氧化碳张力上升69.0%；近红外光谱组织氧饱和度下降35.7%；扫描激光多普勒成像下降78.8%。激光多普勒成像是唯一在部分阻塞时显著下降（p<0.01）的非侵入性设备，从222.8±77.3单位降至186.5±73.2单位（16.3%）。
结论
作者建立了静脉阻塞皮瓣模型，并在部分和完全静脉阻塞期间评估了四种临床相关监测设备。所有设备均能检测到完全阻塞，但只有扫描激光多普勒成像和动脉多普勒能检测到部分阻塞。扫描激光多普勒成像监测可能会对即将发生的静脉阻塞发出预警。近红外光谱组织氧饱和度在各皮瓣间变化最小，因此可能是用于完全静脉阻塞时最易于解读的设备。这两个特性对临床应用均很重要。
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