Wenig B L
Department of Otolaryngology-Head and Neck Surgery, University of Illinois College of Medicine, Chicago.
Laryngoscope. 1993 Sep;103(9):1002-12. doi: 10.1288/00005537-199309000-00011.
Introduction of microvascular free-tissue transfer to head and neck surgery has completely altered the current approach to extirpation and reconstruction. The increased flexibility now available offers multiple options for reconstruction and has essentially removed the limitations of size and geometry which existed with other types of repair. Despite these advantages, increased surgical time and potential flap failure loom as limiting factors. Since the initial use of sutures to perform microvascular anastomoses, numerous experiments have been conducted in order to identify other options for vessel approximation. Laser-assisted microvascular anastomosis (LAMA) was first attempted with the neodymium-yttrium aluminum garnet (Nd:YAG) laser and, subsequently, other wavelengths were used in experimental models. Success with this technique has been repeatedly documented. Although a comparable animal model to study skin flaps was initially described in 1979, little is currently available in the literature that describes the actual use of a microvascular free flap model. Certainly, nothing exists regarding the role of LAMA and microvascular free-tissue transfer. This study was designed to establish a reliable and reproducible animal model to study free-tissue transfer. Through the use of laser Doppler flowmetry, values of blood perfusion of flaps can be determined. Anastomoses with standard suture and various laser-assisted techniques could then be done and compared, analyzing the parameters of time and blood flow. Histologic evaluation could be correlated with clinical observations. In so doing, LAMA could be objectively evaluated as a potentially viable method of vascular reconstruction in microsurgical free-tissue transfer.
微血管游离组织移植引入头颈外科手术，彻底改变了目前的切除与重建方法。如今可利用的灵活性增加，为重建提供了多种选择，基本消除了其他修复方式存在的尺寸和几何形状限制。尽管有这些优势，但手术时间增加和皮瓣潜在失败成为限制因素。自从最初使用缝线进行微血管吻合以来，已经进行了大量实验，以确定血管吻合的其他方法。激光辅助微血管吻合术（LAMA）最初是用钕钇铝石榴石（Nd:YAG）激光尝试的，随后在实验模型中使用了其他波长。这项技术的成功已被多次记录。虽然1979年最初描述了一种用于研究皮瓣的可比动物模型，但目前文献中很少有描述微血管游离皮瓣模型实际应用的内容。当然，关于LAMA和微血管游离组织移植的作用尚无相关报道。本研究旨在建立一个可靠且可重复的动物模型来研究游离组织移植。通过使用激光多普勒血流仪，可以确定皮瓣的血液灌注值。然后可以进行标准缝线吻合和各种激光辅助技术吻合，并进行比较，分析时间和血流参数。组织学评估可以与临床观察结果相关联。这样一来，LAMA作为显微外科游离组织移植中一种潜在可行的血管重建方法就可以得到客观评估。
