Woo S H, Kim S E, Lee T H, Jeong J H, Seul J H
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Taegu, Korea.
Plast Reconstr Surg. 1998 Apr;101(5):1280-9. doi: 10.1097/00006534-199804050-00019.
The purpose of this study was to evaluate further factors that could explain the survival mechanism in the arterialized venous flap. The authors used 16 canines to investigate the survival rate and pattern of the arterialized venous flap and compared the results with those of the conventional saphenous flap. The number and distribution of draining veins in the arterialized venous flap group were varied to observe their impact on the survival rate and pattern. Gross examination of venous network, blood gas, venogram, blood pressure, and histologic study were also carried out. Although there was no significant difference in final survival rate between conventional flap and arterialized venous flap with two efferent veins (p > 0.01), that of the arterialized venous flap increased significantly as the number of draining veins increased. Blood gas analysis showed that more effective oxygen consumption took place when the number of draining veins increased. By measuring the blood flow and volume at 8 hours after the operation with a laser Doppler flowmeter, it was possible to predict the necrosis of the arterialized venous flap. Attachment to a high pressure arterial blood flow system induced smooth muscle proliferation and neogrowth of elastic fibers in the veins. Furthermore, progressive narrowing of the lumen hastened the development of a collateral circulation, demonstrated on a venogram by the tortuous vessels and neovascularization up to the flap margin. To make it possible to predict and achieve complete survival of the arterialized venous flap, the following criteria must be considered: (a) an arterialized venous flap should be designed to contain most of the venous network in the center, (b) the arterial inflow has to be anastomosed to one afferent vein, (c) two or more efferent veins should drain the arterialized venous flap.
本研究的目的是进一步评估能够解释动脉化静脉皮瓣存活机制的因素。作者使用16只犬来研究动脉化静脉皮瓣的存活率和存活模式，并将结果与传统大隐静脉皮瓣的结果进行比较。改变动脉化静脉皮瓣组中引流静脉的数量和分布，以观察它们对存活率和存活模式的影响。还进行了静脉网络的大体检查、血气分析、静脉造影、血压测量以及组织学研究。尽管传统皮瓣与有两条传出静脉的动脉化静脉皮瓣在最终存活率上无显著差异（p>0.01），但动脉化静脉皮瓣的存活率随引流静脉数量的增加而显著提高。血气分析表明，随着引流静脉数量的增加，氧消耗更有效。通过使用激光多普勒血流仪在术后8小时测量血流量和血容量，可以预测动脉化静脉皮瓣的坏死情况。与高压动脉血流系统相连会导致静脉中平滑肌增殖和弹性纤维新生。此外，管腔的逐渐狭窄加速了侧支循环的形成，静脉造影显示为迂曲血管和直至皮瓣边缘的新生血管。为了能够预测并实现动脉化静脉皮瓣的完全存活，必须考虑以下标准：（a）动脉化静脉皮瓣应设计成使大部分静脉网络位于中央；（b）动脉流入应与一条传入静脉吻合；（c）两条或更多条传出静脉应引流动脉化静脉皮瓣。
