Bayati S, Russell R C, Roth A C
Southern Illinois University, School of Medicine, Institute for Plastic and Reconstructive Surgery, Springfield 62794-9230, USA.
Plast Reconstr Surg. 1998 Apr;101(5):1290-5. doi: 10.1097/00006534-199804050-00020.
The cutaneous area in a prefabricated myocutaneous flap surviving after elevation is dependent on the rate and amount of vascular ingrowth that occurs from the underlying muscle. Two modalities, basic fibroblast growth factor and hyperbaric oxygen, were used separately and together in a prefabricated myocutaneous flap animal model to improve flap survival. The semimembranous muscle, based on the saphenous vessels of 40 female Wistar rats weighing between 250 and 325 grams, was tunneled under the ipsilateral abdominal skin and sutured in place. A 3 x 5-cm silicone sheet was placed beneath the muscle flap, and the ipsilateral epigastric vessels were ligated. Four groups of 10 animals each received one of the following treatment regimes: a 1-ml normal saline infusion into the saphenous arterial pedicle, a 1-ml infusion of basic fibroblast growth factor (1.0 microg/gm of muscle), a 1-ml normal saline infusion and 14 hyperbaric oxygen treatments, or a 1-ml basic fibroblast growth factor infusion and 14 hyperbaric oxygen treatments. After 1 week, the muscle, still based on the saphenous vessels, was elevated with a 3 x 5-cm abdominal skin paddle. The flap was sutured back in place, leaving the silicone sheet intact. The surviving area of each flap was measured 1 week later after it had demarcated into viable and necrotic regions. Laser Doppler skin perfusion measurements were taken before and after flap elevation and before animal euthanasia. Sixteen flaps, 4 in each group, were examined histologically for vascularity by means of hematoxylin and eosin staining. There was a statistically significant increase in flap survival area when either basic fibroblast growth factor or hyperbaric oxygen was used alone. Further improvement was noted with combination therapy. Histology confirmed improved vascularity in the basic fibroblast growth factor and hyperbaric oxygen-treated flaps. This study shows a significant and reliable increase in the area of prefabricated myocutaneous flap survival using either basic fibroblast growth factor or hyperbaric oxygen. There is a further complementary effect when these two modalities are combined, leading to near complete flap survival through improved vascularity.
预制肌皮瓣掀起后存活的皮肤面积取决于来自其下方肌肉的血管长入速率和数量。在预制肌皮瓣动物模型中，分别单独使用以及联合使用两种方法，即碱性成纤维细胞生长因子和高压氧，以提高皮瓣存活率。以40只体重在250至325克之间的雌性Wistar大鼠的隐静脉为蒂，将半膜肌经皮下隧道转移至同侧腹部皮肤下方并缝合固定。在肌皮瓣下方放置一张3×5厘米的硅胶片，并结扎同侧的腹壁血管。每组10只动物，共四组，分别接受以下治疗方案之一：向隐动脉蒂内注入1毫升生理盐水；注入1毫升碱性成纤维细胞生长因子（1.0微克/克肌肉）；注入1毫升生理盐水并进行14次高压氧治疗；注入1毫升碱性成纤维细胞生长因子并进行14次高压氧治疗。1周后，以隐静脉为蒂掀起带有3×5厘米腹部皮肤瓣的肌肉。将皮瓣缝合回原位，硅胶片保持完整。1周后，待皮瓣已划分为存活区和坏死区，测量每个皮瓣的存活面积。在皮瓣掀起前后以及动物安乐死之前，进行激光多普勒皮肤灌注测量。每组取4个皮瓣，共16个皮瓣，通过苏木精-伊红染色进行组织学检查以观察血管分布情况。单独使用碱性成纤维细胞生长因子或高压氧时，皮瓣存活面积有统计学意义的显著增加。联合治疗有进一步改善。组织学证实碱性成纤维细胞生长因子和高压氧治疗的皮瓣血管分布改善。本研究表明，使用碱性成纤维细胞生长因子或高压氧可显著且可靠地增加预制肌皮瓣的存活面积。这两种方法联合使用时有进一步的互补效应，通过改善血管分布使皮瓣几乎完全存活。
