Odland R M, Rice R D
Department of Surgery, Loma Linda University School of Medicine, CA 92350, USA.
Otolaryngol Head Neck Surg. 1995 Jul;113(1):92-8. doi: 10.1016/S0194-59989570150-8.
Reproducing the benefits of the delay phenomenon without the risks and costs of a surgical procedure has long been a goal of skin flap physiologists. After the success of the suture-delay technique and argon tunable dye laser in improving survival in McFarlane skin flaps, important questions remained: (1) will laser delay be effective in dermal flaps, (2) can induction of collateral blood flow be documented, and (3) is the KTP laser, which is generally more available to otolaryngologists, more effective than the argon tunable dye laser.
The KTP and argon tunable dye lasers were compared by use of the laser-delay technique, with two outcome measures - blood flow and survival. The laser-delay procedure was accomplished with the laser in a noncutting mode in an attempt to coagulate cutaneous vessels at the periphery of a planned skin flap. The objective was to induce collateralization and improve skin flap survival. Patterns of blood flow were tested by use of the base occlusion test. Flap survival of an acute control flap group was compared with that of the laser delay groups.
Blood flowing to the distal flap area originated from the base of the flap area after laser delay. Flap survival of the laser delay groups was significantly improved over that of the control group.
Both lasers were able to effectively induce collateralization and improve flap survival.
在不承担外科手术风险和成本的情况下重现延迟现象的益处，长期以来一直是皮瓣生理学家的目标。在缝线延迟技术和氩可调染料激光在提高麦克法兰皮瓣存活率方面取得成功之后，重要的问题仍然存在：（1）激光延迟对真皮瓣是否有效，（2）能否记录侧支血流的诱导情况，以及（3）对耳鼻喉科医生来说通常更容易获得的钾钛磷光（KTP）激光是否比氩可调染料激光更有效。
通过激光延迟技术比较KTP激光和氩可调染料激光，采用两个结果指标——血流和存活率。激光延迟操作是在激光非切割模式下完成的，试图凝固计划皮瓣周边的皮肤血管。目的是诱导侧支循环形成并提高皮瓣存活率。通过基础闭塞试验测试血流模式。将急性对照皮瓣组的皮瓣存活率与激光延迟组进行比较。
激光延迟后，流向皮瓣远端区域的血流源自皮瓣区域的基部。激光延迟组的皮瓣存活率明显高于对照组。
两种激光都能够有效诱导侧支循环形成并提高皮瓣存活率。
