Matsumoto Noriko M, Aoki Masayo, Nakao Junichi, Peng Wei-Xia, Takami Yoshihiro, Umezawa Hiroki, Akaishi Satoshi, Ohashi Ryuji, Naito Zenya, Ogawa Rei
Tokyo, Japan.
From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School; and the Department of Pathology and the Department of Integrated Diagnostic Pathology, Graduate School of Medicine, Nippon Medical School Hospital.
Plast Reconstr Surg. 2017 Jan;139(1):79e-84e. doi: 10.1097/PRS.0000000000002900.
The commonly used flap models have drawbacks that limit their usefulness. In the random skin flap model, flap necrosis is caused by both arterial and venous insufficiency. In the axial skin flap model, flap viability is easily affected by the pedicle blood flow and can result in complete necrosis. This study aimed to establish a new rat skin flap model that has a consistent flap survival rate and in which venous congestion and arterial ischemia can be readily distinguished macroscopically.
Rats underwent reverse U-shaped bipedicled superficial epigastric artery flap elevation. The right superficial epigastric vessels formed the pedicle. In the control rats (n = 3), the left superficial epigastric vessels were left intact. In the ischemia group (n = 10), the left superficial epigastric artery was ligated. In the congestion group (n = 10), the left superficial epigastric vein was ligated. The flap was returned to the original site and sutured. The surrounding neovascularization was blocked by polyurethane film. Flap survival rates were evaluated on postoperative day 3.
The flaps in the ischemia and congestion groups were noticeably pale and violet, respectively. Flap necrosis was noted in the contralateral distal zone only. It started on postoperative day 2 in the ischemia and congestion groups. The mean flap survival rates of the control, ischemia, and congestion groups were 100 percent, 61.8 percent (range, 56.9 to 67.1 percent), and 42.3 percent (35.7 to 48.7 percent), respectively (all p < 0.001).
The flap facilitated discrimination of the effects of ischemia and congestion. This new rat skin flap model is simple and easy to construct, and has a consistent flap survival rate.
常用的皮瓣模型存在局限性，影响其应用。在随意型皮瓣模型中，皮瓣坏死是由动脉和静脉供血不足共同导致的。在轴型皮瓣模型中，皮瓣的存活情况容易受到蒂部血流的影响，可能导致完全坏死。本研究旨在建立一种新的大鼠皮瓣模型，该模型皮瓣存活率一致，且能在宏观上轻易区分静脉淤血和动脉缺血情况。
大鼠行反向U形双蒂腹壁浅动脉皮瓣掀起术。以右侧腹壁浅血管作为蒂部。对照组（n = 3）大鼠，左侧腹壁浅血管保持完整。缺血组（n = 10）大鼠，结扎左侧腹壁浅动脉。淤血组（n = 10）大鼠，结扎左侧腹壁浅静脉。将皮瓣复位并缝合。用聚氨酯薄膜阻断周围新生血管形成。于术后第3天评估皮瓣存活率。
缺血组和淤血组皮瓣分别明显苍白和发紫。仅对侧远端区域出现皮瓣坏死。缺血组和淤血组均于术后第2天开始出现坏死。对照组、缺血组和淤血组皮瓣平均存活率分别为100%、61.8%（范围56.9%至67.1%）和42.3%（35.7%至48.7%）（均p < 0.001）。
该皮瓣有助于区分缺血和淤血的影响。这种新的大鼠皮瓣模型简单易构建，且皮瓣存活率一致。
