Bailet J W, Hoffman L F, Trachy R E, Weymuller E A
Division of Head and Neck Surgery, UCLA School of Medicine.
Laryngoscope. 1994 Mar;104(3 Pt 1):253-8. doi: 10.1288/00005537-199403000-00002.
Maintaining the viability of an extended skin flap remains one of the continuing challenges in reconstructive surgery. As flaps lengthen, viability becomes more unpredictable and necrosis of distal segments can occur. The specific mechanisms involved in determining flap survival remain unclear, but vasoconstriction within the flap microcirculation appears to play a significant role in regulating flap viability. Vasodilators have been used, with limited success, in an attempt to improve survival of ischemic skin flaps in rats. One such agent, nifedipine, a calcium channel blocker, demonstrated conflicting results when used to improve rat skin flap survival, despite its potent vasodilating properties. A standard rat flap model was used to help clarify the potential of nifedipine to salvage ischemic skin flaps. Alterations in flap perfusion were assessed using a laser Doppler flowmeter and dermofluorometry in an attempt to characterize nifedipine's mechanism of action on flap preservation. Increased flap survival was demonstrated in treatment animals when compared to controls. Despite significant improvement in flap viability, perfusion measurements failed to confirm increased flow within the flap microcirculation. Although the mechanisms of action remain speculative, nifedipine may have important therapeutic potential in improving skin flap survival in a clinical setting.
维持超长皮瓣的存活能力仍然是重建外科手术中持续存在的挑战之一。随着皮瓣长度增加，其存活能力变得更难预测，远端部分可能会发生坏死。决定皮瓣存活的具体机制尚不清楚，但皮瓣微循环中的血管收缩似乎在调节皮瓣存活能力方面发挥着重要作用。血管扩张剂已被用于尝试提高大鼠缺血皮瓣的存活率，但效果有限。其中一种药物硝苯地平，是一种钙通道阻滞剂，尽管具有强大的血管扩张特性，但在用于提高大鼠皮瓣存活率时却得出了相互矛盾的结果。使用标准大鼠皮瓣模型来帮助阐明硝苯地平挽救缺血皮瓣的潜力。使用激光多普勒血流仪和皮肤荧光测定法评估皮瓣灌注的变化，试图确定硝苯地平对皮瓣保存的作用机制。与对照组相比，治疗组动物的皮瓣存活率有所提高。尽管皮瓣存活能力有显著改善，但灌注测量未能证实皮瓣微循环内的血流增加。虽然作用机制仍属推测，但硝苯地平在临床环境中提高皮瓣存活率方面可能具有重要的治疗潜力。
