Farrior E H, Baker S R
Department of Otolaryngology, University of Michigan, Ann Arbor.
Arch Otolaryngol Head Neck Surg. 1988 Dec;114(12):1385-8. doi: 10.1001/archotol.1988.01860240035018.
We attempted to demonstrate that the totally amputated rabbit auricle could survive on nutrient flow provided through arterialization of the venous system. It has been demonstrated by Mundy and Panje that a free flap placed on a large recipient bed and receiving nutrients through retrograde venous flow will survive as frequently as one in which a conventional microvascular anastomosis has been performed. Our groups examined (1) conventional microvascular anastomosis of the amputated appendage to establish survival and demonstrate proficiency with the technique; (2) survival when only venous egress is maintained; and (3) effectiveness of establishing nutrient flow through arterialization of the venous system. Nutrient flow in the first group was through the arterial system. In the second group no nutrient flow was established, but the venous system remained intact. In the last group, nutrient flow existed through retrograde venous profusion. Survival within the groups that underwent reestablishment of nutrient flow through a conventional reanastomosis or through arterialization of the venous system was not significantly different. There were no surviving segments if nutrient flow was not reestablished, but venous channels remained intact. It was shown that nutrient flow to a free-standing appendage can be established through retrograde venous profusion, and that maintenance of venous drainage alone is not sufficient for survival when a limited base exists. We suggest that arterialization of the venous system is a viable means of reestablishing nutrient flow to the amputated auricle.
我们试图证明，完全离断的兔耳廓能够依靠通过静脉系统动脉化提供的营养血流而存活。Mundy和Panje已经证明，置于大的受区床并通过逆行静脉血流接受营养的游离皮瓣，其存活几率与进行传统微血管吻合的皮瓣一样高。我们的研究小组考察了：（1）将离断的附属器进行传统微血管吻合以确定其能否存活并展示该技术的熟练程度；（2）仅维持静脉流出道时的存活情况；（3）通过静脉系统动脉化建立营养血流的有效性。第一组的营养血流通过动脉系统。第二组未建立营养血流，但静脉系统保持完整。最后一组通过逆行静脉灌注存在营养血流。通过传统再吻合或静脉系统动脉化重建营养血流的组内存活率无显著差异。如果未重建营养血流但静脉通道保持完整，则无存活节段。结果表明，通过逆行静脉灌注可为独立的附属器建立营养血流，并且当基底有限时，仅维持静脉引流不足以使其存活。我们认为，静脉系统动脉化是为离断的耳廓重建营养血流的一种可行方法。
