Song Jian, Li Zonghuan, Yu Aixi
Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.
Exp Ther Med. 2016 Jan;11(1):318-324. doi: 10.3892/etm.2015.2869. Epub 2015 Nov 16.
Flow-through skin flap grafting is becoming widely used for the reconstruction of skin and soft tissue defects, particularly for patients with poor blood supply around the defect. However, the treatment of the veins remains controversial. In the present study, 5×2-cm skin flaps were created on the left inner thighs of rabbits in order to investigate the effects of various treatments of the veins on the survival of a flow-through skin flap. A femoral artery perforator running through the flap was preserved. Five groups were established in which no veins, one superficial vein (SV), one accompanying vein (AV), one SV plus one AV, or all trunk veins (control) were retained. The percentage of flap area survival was determined on day 10. On days 3, 5, 7 and 9, tissues were harvested from the skin flaps and immunohistochemical analysis was performed in order to count the number of microvessels. Western blot analysis was subsequently completed in order to determine the expression levels of vascular endothelial growth factor (VEGF). The flap areas in which no veins were retained demonstrated significantly reduced survival rates on day 10, as compared with those in the other four groups (P<0.01). Furthermore, flaps with the retention of a SV also demonstrated reduced survival rates, as compared with the AV, AV plus SV and all veins groups (P<0.01); however, there no significant differences were detected between the latter three groups (P>0.05). Immunohistochemical analysis on day 3 detected a greater number of microvessels in the flaps of the control group, as compared with the flaps of the other groups. Furthermore, the AV and AV plus SV groups demonstrated a greater number of microvessels, as compared with the SV and no vein groups, and he no vein group demonstrated the fewest microvessels. No significant differences were found between the AV, AV plus SV and control groups on day 5, 7 and 9. Western blot analysis on day 5 demonstrated that the expression levles of VEGF were significantly increased in the flaps of the AV, AV plus SV and control groups, as compared with those in the SV and no vein groups. No significant differences were detected between the former three groups, and increased VEGF expression levels were detected in the flaps of the SV group, as compared with the no vein group. The flow-through flap grafts with no retained veins barely survived. Anastomosing one AV was adequate for flap survival; however, further studies are required in order to investigate the survival of flow-through flaps in more detail.
穿支皮瓣移植正被广泛用于皮肤和软组织缺损的修复，尤其适用于缺损周围血供较差的患者。然而，静脉的处理仍存在争议。在本研究中，在兔左大腿内侧制备5×2厘米的皮瓣，以研究静脉的不同处理方式对穿支皮瓣存活的影响。保留一条穿过皮瓣的股动脉穿支。设立五组，分别为不保留静脉、保留一条浅静脉（SV）、保留一条伴行静脉（AV）、保留一条SV加一条AV或保留所有主干静脉（对照组）。在第10天测定皮瓣存活面积百分比。在第3、5、7和9天，从皮瓣取材进行免疫组化分析以计数微血管数量。随后进行蛋白质印迹分析以测定血管内皮生长因子（VEGF）的表达水平。与其他四组相比，不保留静脉的皮瓣在第10天的存活率显著降低（P<0.01）。此外，与保留AV、AV加SV和保留所有静脉的组相比，保留SV的皮瓣存活率也降低（P<0.01）；然而，后三组之间未检测到显著差异（P>0.05）。第3天的免疫组化分析显示，与其他组的皮瓣相比，对照组皮瓣中的微血管数量更多。此外，与保留SV和不保留静脉的组相比，保留AV和AV加SV的组微血管数量更多，不保留静脉的组微血管数量最少。在第5、7和9天，AV、AV加SV和对照组之间未发现显著差异。第5天的蛋白质印迹分析显示，与保留SV和不保留静脉的组相比，保留AV、AV加SV和对照组皮瓣中VEGF的表达水平显著升高。前三组之间未检测到显著差异，与不保留静脉的组相比，保留SV组皮瓣中VEGF表达水平升高。不保留静脉的穿支皮瓣几乎无法存活。吻合一条AV足以维持皮瓣存活；然而，需要进一步研究以更详细地探讨穿支皮瓣存活情况。
