Cederna P S, Chang P, Pittet-Cuenod B M, Razaboni R M, Cram A E
Department of Surgery, University of Iowa College of Medicine, Iowa City, USA.
Plast Reconstr Surg. 1997 Jan;99(1):183-93. doi: 10.1097/00006534-199701000-00027.
The beneficial effects of the delay phenomenon have been evaluated extensively and are widely known. However, no study has quantified the vascular changes seen in an abdominal cutaneous island flap following a surgical delay by vascular pedicle ligation. We evaluated the effect of unilateral superficial inferior epigastric and deep inferior epigastric pedicle ligation on the vascularity of a rabbit abdominal cutaneous island flap. Thirty rabbits underwent a left superficial inferior epigastric and deep inferior epigastric pedicle ligation as a delay procedure. A 19 x 15 cm abdominal cutaneous island flap was elevated at the time of sacrifice, based solely on the right superficial inferior epigastric pedicle. The flap vasculature was then evaluated by methylene blue injection and lead oxide microangiography at 0, 5, 10, 15, 21, and 27 days following the delay procedure. Methylene blue studies revealed perfusion of only the right (nonligated) side of the flap on day 0 and perfusion of the entire flap by day 15. This "capture" of the left (ligated) superficial inferior epigastric artery angiosome by day 15 could only have been achieved through enhanced cross-midline perfusion. Lead oxide microangiography revealed an increase in the number of vessels from day 0 to day 27 on both the ligated and nonligated sides in all the following: the number of large "choke" vessels (> 0.5 mm) crossing the flap midline, total number of vessels (all sizes) crossing the flap midline, and total number of vessels (all sizes) at the medial aspect of the right and left superficial inferior epigastric artery angiosomes. A statistically significant increase in these vessels was not seen until day 21. The effect of the delay phenomenon was significantly greater on the ligated side compared with the nonligated side. The areas of the flap that were relatively more ischemic following left superficial inferior epigastric pedicle ligation (medial aspect of the caudad half of the left superficial inferior epigastric artery angiosome) showed greater increases in vascularity with the delay procedure than did areas of lesser ischemia (medial aspect of the cephalad half of the right superficial inferior epigastric artery angiosome).
延迟现象的有益效果已得到广泛评估且广为人知。然而，尚无研究对通过血管蒂结扎进行手术延迟后腹部皮瓣岛状皮瓣中所观察到的血管变化进行量化。我们评估了单侧腹壁浅动脉和腹壁深动脉蒂结扎对兔腹部皮瓣岛状皮瓣血管形成的影响。30只兔子接受了左侧腹壁浅动脉和腹壁深动脉蒂结扎作为延迟手术。在处死时掀起一个19×15cm的腹部皮瓣岛状皮瓣，仅以右侧腹壁浅动脉蒂为蒂。然后在延迟手术后0、5、10、15、21和27天，通过亚甲蓝注射和氧化铅微血管造影评估皮瓣的血管系统。亚甲蓝研究显示，术后0天皮瓣仅右侧（未结扎侧）有灌注，至15天时整个皮瓣均有灌注。到15天时左侧（结扎侧）腹壁浅动脉血管体的这种“捕获”只能通过增强的跨中线灌注来实现。氧化铅微血管造影显示，在以下所有方面，从术后0天到27天，结扎侧和未结扎侧的血管数量均增加：穿过皮瓣中线的大“阻塞”血管（>0.5mm）数量、穿过皮瓣中线的血管总数（所有大小）以及左右腹壁浅动脉血管体内侧的血管总数（所有大小）。直到21天这些血管才出现统计学上的显著增加。与未结扎侧相比，延迟现象对结扎侧的影响显著更大。左侧腹壁浅动脉蒂结扎后相对缺血更严重的皮瓣区域（左侧腹壁浅动脉血管体尾侧半的内侧）与缺血较轻的区域（右侧腹壁浅动脉血管体头侧半的内侧）相比，延迟手术后血管形成的增加更为明显。
