摘要目的 探讨皮神经营养血管对扩大穿支皮瓣存活面积的机制.方法 雄性SD大鼠30只,10只用于灌注解剖研究大鼠背部穿支血管、皮神经走行;20只随机分为两组,均设计3 cm×10 cm以旋髂深动脉皮穿支为蒂的背部长轴皮瓣,实验组皮瓣长轴与后正中线成0°、对照组呈30°.术后1 d、7 d尾静脉注射荧光素钠观察皮瓣血流情况;术后7d观察两组皮瓣存活率,并观察皮瓣的血管网分布.结果 大鼠旋髂深动脉皮穿支恒定,背部皮神经纵向分布,有丰富的血管网伴行.术后1 d实验组的血流灌注面积为42.85%,对照组皮瓣为37.94%,二者差异无统计学意义(P＞0.05);术后7 d两组皮瓣血流灌注面积分别为84.07%、58.55%,皮瓣存活面积分别为83.93%、59.95%,差异均有统计学意义(P＜0.01).术后7 d实验组皮瓣血管网密度高于对照组.结论 皮神经营养血管改善穿支皮瓣存活状况,沿皮神经走向切取穿支皮瓣可明显增大皮瓣存活面积.

abstractsObjective To study the effects of nerocutneous vessels on perforator flap blood supply and survival area. Methods Thirty SD rats were randomly divided into 3 groups. The study of the vasculature and nerve disposition of rat dorsum was performed with 10 rats of one group. According to the study,a distal rectangle neurocutaneous flap based on deep circumflex iliac artery perforator, 10 cm long and 3 cm in the width, was elevated on the rest rats, and sutured back to the original situation. The axis of the experimental group's flap paralleles the posterior median line,while the control group flap's angulated about 30° with it. The blood flow of the flap was assessed by fluorescein angiography on the 1st and 7th day after surgery. The surviving rate and the capillary density of flap were assessed on the 7th day after surgery. Results The rat deep circumflex iliac perforator artery was a constant perforator artery, with an nutrition area about 4 cm× 3 cm. The dorsal cutaneous nerves run along the dorsomedian line, nourished by rich vessels. The blood perfusion 1st day after surgery was 42.85% in the experimental group, 37.94% in the control group(P ＞ 0.01 ).On the 7th day, it was 84.07% in the experimental group, 58.55% in the control group (P＜ 0.01). The mean survival rate of the experimental group was 83.93%, higher than control group's 59.95% (P＜0.01),and the density of the blood vessels was higher in experimental group than control group's. Conclusion The neurocutaneous vessels can improve the flap survival condition, which make the perforator flap bigger and safer.