Numajiri Toshiaki, Sowa Yoshihiro, Nishino Kenichi, Fujiwara Hitoshi, Nakano Hiroshi, Shimada Taketoshi, Nakai Shigeru, Hisa Yasuo
Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan.
Br J Oral Maxillofac Surg. 2011 Mar;49(2):112-5. doi: 10.1016/j.bjoms.2010.02.010. Epub 2010 Mar 24.
The vascular supercharge (additional microvascular anastomosis) has rarely been used for free flaps, and the blood circulation in the transferred tissue has not been recorded. We have made double vascular anastomoses during free jejunal transfer to reduce the possibility of loss of the flap from vascular occlusion. To evaluate the efficacy of additional arterial and venous anastomoses to improve the circulation in the transferred tissue, we analysed the results of blood gas measurements including venous partial pressure of oxygen (pO₂) and carbon dioxide (pCO₂) from the distal arcade vein. The free jejunal transfer was made using two pairs of arterial and venous anastomoses. Blood gas concentrations were analysed in samples drawn from the vein in the jejunal arcade before harvest, after the anastomosis of one paired artery and vein, after an additional arterial anastomosis, and after anastomoses of two pairs of artery/vein. The results showed that the venous pCO₂ was not changed by increasing the number of anastomosed vessels. The venous pO₂ was raised both by an additional arterial anastomosis and by two pairs of anastomoses, compared with that at the other two time points measured (p = 0.04, p = 0.02, respectively). An additional arterial anastomosis seemed to have more effect on the pO₂ than an additional artery/vein pair. Additional arterial and venous supercharging therefore has a similar effect on hyperbaric oxygenation. This effect is mainly caused by arterial supercharging.
血管增压术（额外的微血管吻合术）很少用于游离皮瓣，且转移组织中的血液循环情况尚无记录。我们在游离空肠转移术中进行了双重血管吻合，以降低皮瓣因血管闭塞而坏死的可能性。为评估额外的动静脉吻合对改善转移组织血液循环的效果，我们分析了血气测量结果，包括来自远端弓状静脉的静脉血氧分压（pO₂）和二氧化碳分压（pCO₂）。游离空肠转移术采用了两对动静脉吻合。在空肠取材前、一对动静脉吻合后、额外进行一次动脉吻合后以及两对动静脉吻合后，对取自空肠弓状静脉的样本进行血气浓度分析。结果显示，增加吻合血管数量并未改变静脉pCO₂。与其他两个测量时间点相比，额外进行一次动脉吻合以及两对动静脉吻合均使静脉pO₂升高（分别为p = 0.04，p = 0.02）。额外进行一次动脉吻合对pO₂的影响似乎大于额外增加一对动静脉吻合。因此，额外的动静脉增压对高压氧合具有相似的效果。这种效果主要由动脉增压引起。
