Morris S F, Pang C Y, Mahoney J, Lofchy N, Kaddoura I L, Patterson R, Lista F
Division of Surgical Research, Hospital for Sick Children, Toronto, Ontario, Canada.
Plast Reconstr Surg. 1989 Aug;84(2):314-22; discussion 323-4.
Skin flaps constructed on expanded skin usually include the underlying capsular tissue. It has been hypothesized that capsulectomy may jeopardize the viability of the expanded skin flap. The experiments reported herein were designed to test this hypothesis. Specifically, we studied the hemodynamics and viability of random-pattern skin flaps (8 X 20 cm) raised on delayed bipedicle flaps (group A) and on expanded skin pockets with capsulectomy at the time of flap elevation (group B) or with intact underlying capsular tissue (group C). Each group was randomly assigned to each flank in 16 pigs. Skin pockets were expanded by inflation of subcutaneous silicone tissue expanders with sterile saline (299 +/- 7 ml; X +/- SEM) over a period of 3 weeks. At the end of this period, the bipedicle flaps were constructed. Eight days later, random-pattern skin flaps were raised on bipedicle flaps and skin pockets. The length and area of skin flap viability, judged by the fluorescein dye test performed 1 day postoperatively, were not significantly different (p greater than 0.05) among groups A, B, and C (n = 31 to 32). There also were no significant differences (p greater than 0.05) in total skin capillary blood flow measured 1 day postoperatively (A = 2.6 +/- 0.4, B = 2.4 +/- 0.4, and C = 2.7 +/- 0.6 ml/min per flap; n = 15 to 16) and in skin viability assessed 7 days postoperatively (A = 74 +/- 2, B = 75 +/- 2, and C = 76 +/- 2 percent; n = 16) among delayed skin flaps and skin flaps raised on expanded skin pockets with or without capsulectomy. The results of this flap viability study were confirmed in 5 minipigs in a separate experiment. We conclude that capsulectomy did not have a detrimental effect on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin. Furthermore, we hypothesize that skin flaps raised on expanded skin are similar to delayed skin flaps in that the skin blood flow is optimally augmented; therefore, the capsular tissue does not add significant blood supply to the overlying skin.
在扩张皮肤上构建的皮瓣通常包括其下方的包膜组织。有假说认为，包膜切除术可能会危及扩张皮瓣的存活能力。本文报道的实验旨在验证这一假说。具体而言，我们研究了在延迟双蒂皮瓣（A组）、皮瓣掀起时行包膜切除术的扩张皮肤袋（B组）或保留下方完整包膜组织的扩张皮肤袋（C组）上掀起的随意型皮瓣（8×20厘米）的血流动力学和存活能力。每组随机分配至16头猪的两侧腹。通过向皮下硅橡胶组织扩张器内注入无菌生理盐水（299±7毫升；平均值±标准误），在3周时间内对皮肤袋进行扩张。在此阶段结束时，构建双蒂皮瓣。8天后，在双蒂皮瓣和皮肤袋上掀起随意型皮瓣。术后1天通过荧光素染料试验判断的皮瓣存活长度和面积，A、B、C组之间无显著差异（p＞0.05）（n = 31至32）。术后1天测量的皮瓣总皮肤毛细血管血流量（A组 = 2.6±0.4、B组 = 2.4±0.4、C组 = 2.7±0.6毫升/分钟·皮瓣；n = 15至16）以及术后7天评估的皮肤存活能力（A组 = 74±2、B组 = 75±2、C组 = 76±2%；n = 16），在延迟皮瓣以及在有或无包膜切除术的扩张皮肤袋上掀起的皮瓣之间也无显著差异（p＞0.05）。在另一项实验中，5只小型猪的实验结果证实了该皮瓣存活能力研究的结果。我们得出结论，包膜切除术对在扩张皮肤上掀起的随意型皮瓣的血流动力学和存活能力没有不利影响。此外，我们推测在扩张皮肤上掀起的皮瓣与延迟皮瓣相似，即皮肤血流得到最佳增强；因此，包膜组织并未为上方皮肤增加显著的血液供应。
