Aggarwal Krittika, Singh Arun K, Halageri Sameer M, Kumar Vijay, Mishra Brijesh, Upadhyay D N
Department of Plastic Surgery, King George Medical College, Lucknow, Uttar Pradesh, India.
Indian J Plast Surg. 2021 Jan;54(1):69-74. doi: 10.1055/s-0041-1725227. Epub 2021 Mar 10.
Reconstruction forms the primary tenet in plastic surgery. Venous flaps are a known option but the survival is limited. Arterialization of venous flap can enhance its survival. While various techniques of arterialization of venous flaps are described, there are very few studies comparing them. The current study was conducted among 34 rats weighing 160 to 200 grams. The rats were divided into four groups. Group I-islanded epigastric flap was raised with superficial caudal epigastric vessels as pedicle. Group II-arterialized flow through venous flap was raised with superficial caudal epigastric vein (SCEV) as afferent and lateral thoracic vein as drainage vein. Side-to-side anastomosis was done between femoral artery and vein, lateral to the origin of superficial caudal epigastric artery. Group III-after raising the flap, as in group II, femoral vein was ligated proximal to superficial caudal epigastric vessels. Group IV-an arterialized flow through venous flap was raised with superficial caudal epigastric vein as afferent and lateral thoracic vein as drainage vein. End-to-side anastomosis was done between femoral artery and superficial caudal epigastric vein. Animals that died before completion of the study were excluded. The color changes of flaps were noted. Flap survival was expressed as a percentage of the total flap surface area. The patency of anastomosis was seen on postoperative day 5. There was no total flap failure. On statical analysis, the flap survival area on day 5 between Group I and Group IV was not significant ( value 0.431). The survival area in Group I (78.85 ± 10.54%) was comparable to Group IV (65.71 ± 20.70%). Group II and III had poor results as compared with Group I. In four rats, thrombosis of arteriovenous anastomosis was noted with flap survival area of 30 to 33%. It was noted that epigastric venous flaps with end-to-side anastomosis between femoral artery and superficial caudal epigastric vein (group IV) have survival area comparable to islanded flaps.
重建是整形手术的首要原则。静脉皮瓣是一种已知的选择，但存活率有限。静脉皮瓣的动脉化可以提高其存活率。虽然描述了多种静脉皮瓣动脉化技术，但比较这些技术的研究很少。
本研究在34只体重160至200克的大鼠中进行。大鼠被分为四组。第一组——以腹壁浅尾侧血管为蒂掀起岛状腹壁皮瓣。第二组——以腹壁浅尾侧静脉（SCEV）为输入血管、胸外侧静脉为引流静脉掀起动脉化血流通过的静脉皮瓣。在腹壁浅尾侧动脉起始部外侧，在股动脉和静脉之间进行端侧吻合。第三组——掀起皮瓣后，与第二组一样，在腹壁浅尾侧血管近端结扎股静脉。第四组——以腹壁浅尾侧静脉为输入血管、胸外侧静脉为引流静脉掀起动脉化血流通过的静脉皮瓣。在股动脉和腹壁浅尾侧静脉之间进行端侧吻合。在研究完成前死亡的动物被排除。记录皮瓣的颜色变化。皮瓣存活率以皮瓣总面积的百分比表示。术后第5天观察吻合口通畅情况。
没有皮瓣完全坏死。经统计学分析，第一组和第四组在第5天的皮瓣存活面积无显著差异（P值0.431）。第一组的存活面积（78.85±10.54%）与第四组（65.71±20.70%）相当。与第一组相比，第二组和第三组的结果较差。在4只大鼠中，观察到动静脉吻合处血栓形成，皮瓣存活面积为30%至33%。
值得注意的是，股动脉与腹壁浅尾侧静脉之间进行端侧吻合的腹壁静脉皮瓣（第四组）的存活面积与岛状皮瓣相当。
