静脉血营养手掌部脱套皮肤成活的实验与临床研究
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摘要
目的：通过基础与临床三个试验相结合，探讨静脉血营养对脱套皮肤成活及成活质量的影响以及皮肤在低静脉血营养条件下的成活机制，为临床吻合浅静脉治疗手掌部皮肤撕脱伤寻找科学依据。
方法：实验一：以新泽西白兔为试验模型，选择新泽西白兔16只，将其双下肢随机分为试验侧和对照侧，A组为实验组，B组为对照组；A、B两组动物双后肢均形成3：1的脱套皮肤，以踝关节为蒂，其中，试验侧吻合两条回流静脉，对照原位缝合。术后通过大体观察、皮肤组织活检及皮肤成活面积统计等3种方法观察皮瓣成活情况。实验二：通过观察乳胶灌注实体标本，了解手掌部浅静脉的走行，分布，并测量其直径，为临床治疗寻找解剖学依据。实验三：临床上吻合皮肤浅静脉治疗手掌部皮肤脱套伤，以验证该手术方式的临床使用价值。
结果：实验一：试验侧脱套皮肤在各项成活指标方面均强于对照侧。实验二：手掌部有可供吻合的浅静脉。实验三：通过吻合浅静脉治疗手掌部皮肤撕脱伤24例，其中21例皮肤全部成活，成活率87.5％，另外3列除掌部有约1.5×1.0厘米的皮肤坏死
论文：静脉血营养手掌部脱套皮肤成活的实验与临床研究
外，其余部分成活。经2－5年的随访，皮肤外形美观，耐磨擦能
力强，基本恢复了原来的功能。
结论：通过吻合残静脉治疗手掌部皮肤撕脱伤，通过静脉血
回流，维持皮肤低营养，能使皮瓣成活面积和成活质量均明显提
高。该试验结果对临床手掌部皮肤脱套伤的治疗开辟了一条较为
理想的途径。
Object The influence of venous-blood to to nurture the avulsion skin and the skin survival mechanism are studied hi these experiments using New Zealand white rabbits and the specimen hands as model. To evaluate the treatment of avulsion injury of palmar skin .
Method : Experiment 1 :There are 16 New Zealand white rabbits in experiment 1 .The prosterior limbs of the rabbits are divided into experimental and control groups at random, group A is experimental;group B is control 3:1 distal-based-avulsion skin is made in the animals of group A and B respectively. Two veins are anastomosised in experimental side. As control another side is just sutured back to the original site. The survival condition is evaluated based on observation pathological examination and survival area calculating. Experiment 2: In order to provide scientific basis for clinical practice, we observe the hands of the specimen to know the run of palmaris superficial vein in the hands. Experiment 3: 24 cases of avulsion injury of palmar skin were primarily by anastomosing the arcus venous palmarris superficialis. 21 cases as control is just sutured back to the original site.
Result rExperiment l:The survival condition of experimental group skin is better than that of control group skin based on these detection methods. t=7.140>to.o1(11), p<0.01.Experiment 2: there are many superficial venous need to be anastomot in the palmar skin. Experiment 3:The avulsion skins of 24 patients are alive. The excellent and good rate of hand function is 87.5%.
Conclusion: Venous-blood-flow is very important to avulsion palmar-skin survival,which can augment the quality and area of skin .This therapy open up a path of treatment to the avulsion injury of palmar skin in clinical practice.
方法：实验一：以新泽西白兔为试验模型，选择新泽西白兔16只，将其双下肢随机分为试验侧和对照侧，A组为实验组，B组为对照组；A、B两组动物双后肢均形成3：1的脱套皮肤，以踝关节为蒂，其中，试验侧吻合两条回流静脉，对照原位缝合。术后通过大体观察、皮肤组织活检及皮肤成活面积统计等3种方法观察皮瓣成活情况。实验二：通过观察乳胶灌注实体标本，了解手掌部浅静脉的走行，分布，并测量其直径，为临床治疗寻找解剖学依据。实验三：临床上吻合皮肤浅静脉治疗手掌部皮肤脱套伤，以验证该手术方式的临床使用价值。
结果：实验一：试验侧脱套皮肤在各项成活指标方面均强于对照侧。实验二：手掌部有可供吻合的浅静脉。实验三：通过吻合浅静脉治疗手掌部皮肤撕脱伤24例，其中21例皮肤全部成活，成活率87.5％，另外3列除掌部有约1.5×1.0厘米的皮肤坏死
论文：静脉血营养手掌部脱套皮肤成活的实验与临床研究
外，其余部分成活。经2－5年的随访，皮肤外形美观，耐磨擦能
力强，基本恢复了原来的功能。
结论：通过吻合残静脉治疗手掌部皮肤撕脱伤，通过静脉血
回流，维持皮肤低营养，能使皮瓣成活面积和成活质量均明显提
高。该试验结果对临床手掌部皮肤脱套伤的治疗开辟了一条较为
理想的途径。
Object The influence of venous-blood to to nurture the avulsion skin and the skin survival mechanism are studied hi these experiments using New Zealand white rabbits and the specimen hands as model. To evaluate the treatment of avulsion injury of palmar skin .
Method : Experiment 1 :There are 16 New Zealand white rabbits in experiment 1 .The prosterior limbs of the rabbits are divided into experimental and control groups at random, group A is experimental;group B is control 3:1 distal-based-avulsion skin is made in the animals of group A and B respectively. Two veins are anastomosised in experimental side. As control another side is just sutured back to the original site. The survival condition is evaluated based on observation pathological examination and survival area calculating. Experiment 2: In order to provide scientific basis for clinical practice, we observe the hands of the specimen to know the run of palmaris superficial vein in the hands. Experiment 3: 24 cases of avulsion injury of palmar skin were primarily by anastomosing the arcus venous palmarris superficialis. 21 cases as control is just sutured back to the original site.
Result rExperiment l:The survival condition of experimental group skin is better than that of control group skin based on these detection methods. t=7.140>to.o1(11), p<0.01.Experiment 2: there are many superficial venous need to be anastomot in the palmar skin. Experiment 3:The avulsion skins of 24 patients are alive. The excellent and good rate of hand function is 87.5%.
Conclusion: Venous-blood-flow is very important to avulsion palmar-skin survival,which can augment the quality and area of skin .This therapy open up a path of treatment to the avulsion injury of palmar skin in clinical practice.
引文
1、 颐玉东。四肢的显微外科修复。上海医科大学出版社，1998年11月第1版。
2、 梁智，任林森。带真皮下血管网皮瓣血运重建的实验研究(三)超薄皮瓣的再血管化与血管管化与血供变化。中国修复重建外科杂志，1994，(4)；242-244。
3、 袁启明，潘婕，梁佩红，陈志兴。静脉血营养筋膜瓣存活的探讨。中华显微外科杂志，1986，9(4)：219-221。
4、 张良．手静脉的显微解剖．青岛医学院学报．1982．2：29-31．
5、 Lucas GL. The pattern of venous drinage of digitis. J Hand Surg(Am). 1984.9:448-451.
6、 Spinner M. Kaplan's functional and surgical anatomy of the hand. 3rd ed. Lippincott, Philadelphia, 1984. 203-205
7、 Williams PL, Warwick R. Gray's Anatomy. 37th ed. Churchil llivingstone, Edinberg, 1989. 785-788
8、 Schmidt HM, Lanz U. Chirugische Anatomie der Hand. 1 Aufl.Hippokrates, Stuttgart, 1992.215-218.
9、 Zhang SX, Ho GT, Liu ZJ. Basic vascular anatomy and the reimplantation of the amputated hand through the palm. Surg Radiol Anat, 1990,12:241
10、柏树令，李吉，皮肤微循环血管树间隔区的微血管构筑．微循环杂志．1996，6(2)：1-2。
11、aylor Gl,caddy CM,watterson PA, et al. The venous territories(venosomes) of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1993,46(5): 652.
12 Popper FJ. Studied on the viavility of mammalian skin grafts after storage at different tenperature.. Br J Plast Surg,1954,6:250
13 Suzuki. The minimal requirement of circulation for survival of undelayed and delayed flaps in rats. Rlast Reconstr Surg, 1986,78;221.
14 魏长月，郭德亮，范启申。吻合静脉的撕脱皮瓣原位缝合修复手背皮肤逆行撕脱伤。中华手外科杂志，1998，6．14(2)：72-73。
15 张成进，傅炳峨。手掌严重损伤。见：丁自海，裴国献主编。手外科解剖与临床。济南：山东科学技术出版社，1993．351-265
16 顾玉东著．手的修复与再造．上海：上海医科大学出版社，1995．263-265．
17 Torri S, Namiki Y, Meri R. Plast Reconstr Surg, 1987;79(4):600-609
18 Satoh K, Okabe K, Matdsui A. Eur Plast Surg, 1989; 12(1):171-174
19 Del-Pinal F,Taylor GI. Br J Plast Surg, 1993;46(8):652-664
20 Imanishi N,Nakajima H, Aiso S et al. Br J Plast Reconstr Surg, 1996;97(2):408-412
21 arii K,et al. Use of the grastroepiploic vessels as recipient or donor vessel in the free transfer lf composite flaps by microvascular anastomosis. Plast Rlast Reconst Surg. 1973,52:541
22 孟南方，陆健。四肢大面积皮肤撕脱伤后皮肤坏死原因分析。湖南医学，1997，2；14(1)：21
23 张世民，刘大雄，张连生，韩平良。远断蒂皮瓣血液循环特征及临床意义。中国临床解剖学杂志，1998，16(2)；103-106。
24 Taylor Gl, caddy CM, watterson PA, et al. The venous territories(venosomes) of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1993,46(5):652.
21 成红兵，侍德。猪皮瓣长、宽比例的试验研究。手外科杂志，1987，3：42。
22 梁建，容汗坚，罗盛康，黄健，郑文玲，邱世国。丹参对随意性皮瓣活力影响的微循环研究，中华显微外科杂志，1994，8，17(3)：207-209。
23 Del Pinal F,Taylor Gl. The deep venous system and reverse flow flaps. Br J Surg, 1993,46(5):652.
24 Thomas C V. Thin flap. Plast Reconstr Surg, 1980,65:747.
25 张伯勋，李众利，郭郑生，郭义柱。双蒂阻隔皮瓣内血管及血流变化的试验研究。中华显微外科杂志，1997，8，25；20(3)：210-212。
26 梁建，容汗坚，罗盛康，黄健，郑文玲，邱世国。丹参对随意性皮瓣活力影响的微循环研究，中华显微外科杂志，1994，8，17(3)：207-209。
27 郭杰；鲁开化等．皮肤撕脱伤撕脱皮瓣组织血管活性因子的变化及意义．中华显微外科杂志．1997，V20N3：221-222
28 郭杰；鲁开化等。第四军医大学学报．1997．V18N4：316-318．
29 Cohen BE Beneficeal effect of saged division of pedical in experimental axial---pattern flap. Plast Reconstr Surg, 1979,64;366.
30 Gottrup F, Williams TR, Myers MB, et al. A comparative study of skin blood flow in musculocutaneous and random pattern flaps. J Surg, 1984;73:843.
31 钟德才，陈壁，赵建亚等。真皮下血管网片移植血运重建的实验研究。解放军医学杂志，1983；8；11。
2、 梁智，任林森。带真皮下血管网皮瓣血运重建的实验研究(三)超薄皮瓣的再血管化与血管管化与血供变化。中国修复重建外科杂志，1994，(4)；242-244。
3、 袁启明，潘婕，梁佩红，陈志兴。静脉血营养筋膜瓣存活的探讨。中华显微外科杂志，1986，9(4)：219-221。
4、 张良．手静脉的显微解剖．青岛医学院学报．1982．2：29-31．
5、 Lucas GL. The pattern of venous drinage of digitis. J Hand Surg(Am). 1984.9:448-451.
6、 Spinner M. Kaplan's functional and surgical anatomy of the hand. 3rd ed. Lippincott, Philadelphia, 1984. 203-205
7、 Williams PL, Warwick R. Gray's Anatomy. 37th ed. Churchil llivingstone, Edinberg, 1989. 785-788
8、 Schmidt HM, Lanz U. Chirugische Anatomie der Hand. 1 Aufl.Hippokrates, Stuttgart, 1992.215-218.
9、 Zhang SX, Ho GT, Liu ZJ. Basic vascular anatomy and the reimplantation of the amputated hand through the palm. Surg Radiol Anat, 1990,12:241
10、柏树令，李吉，皮肤微循环血管树间隔区的微血管构筑．微循环杂志．1996，6(2)：1-2。
11、aylor Gl,caddy CM,watterson PA, et al. The venous territories(venosomes) of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1993,46(5): 652.
12 Popper FJ. Studied on the viavility of mammalian skin grafts after storage at different tenperature.. Br J Plast Surg,1954,6:250
13 Suzuki. The minimal requirement of circulation for survival of undelayed and delayed flaps in rats. Rlast Reconstr Surg, 1986,78;221.
14 魏长月，郭德亮，范启申。吻合静脉的撕脱皮瓣原位缝合修复手背皮肤逆行撕脱伤。中华手外科杂志，1998，6．14(2)：72-73。
15 张成进，傅炳峨。手掌严重损伤。见：丁自海，裴国献主编。手外科解剖与临床。济南：山东科学技术出版社，1993．351-265
16 顾玉东著．手的修复与再造．上海：上海医科大学出版社，1995．263-265．
17 Torri S, Namiki Y, Meri R. Plast Reconstr Surg, 1987;79(4):600-609
18 Satoh K, Okabe K, Matdsui A. Eur Plast Surg, 1989; 12(1):171-174
19 Del-Pinal F,Taylor GI. Br J Plast Surg, 1993;46(8):652-664
20 Imanishi N,Nakajima H, Aiso S et al. Br J Plast Reconstr Surg, 1996;97(2):408-412
21 arii K,et al. Use of the grastroepiploic vessels as recipient or donor vessel in the free transfer lf composite flaps by microvascular anastomosis. Plast Rlast Reconst Surg. 1973,52:541
22 孟南方，陆健。四肢大面积皮肤撕脱伤后皮肤坏死原因分析。湖南医学，1997，2；14(1)：21
23 张世民，刘大雄，张连生，韩平良。远断蒂皮瓣血液循环特征及临床意义。中国临床解剖学杂志，1998，16(2)；103-106。
24 Taylor Gl, caddy CM, watterson PA, et al. The venous territories(venosomes) of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1993,46(5):652.
21 成红兵，侍德。猪皮瓣长、宽比例的试验研究。手外科杂志，1987，3：42。
22 梁建，容汗坚，罗盛康，黄健，郑文玲，邱世国。丹参对随意性皮瓣活力影响的微循环研究，中华显微外科杂志，1994，8，17(3)：207-209。
23 Del Pinal F,Taylor Gl. The deep venous system and reverse flow flaps. Br J Surg, 1993,46(5):652.
24 Thomas C V. Thin flap. Plast Reconstr Surg, 1980,65:747.
25 张伯勋，李众利，郭郑生，郭义柱。双蒂阻隔皮瓣内血管及血流变化的试验研究。中华显微外科杂志，1997，8，25；20(3)：210-212。
26 梁建，容汗坚，罗盛康，黄健，郑文玲，邱世国。丹参对随意性皮瓣活力影响的微循环研究，中华显微外科杂志，1994，8，17(3)：207-209。
27 郭杰；鲁开化等．皮肤撕脱伤撕脱皮瓣组织血管活性因子的变化及意义．中华显微外科杂志．1997，V20N3：221-222
28 郭杰；鲁开化等。第四军医大学学报．1997．V18N4：316-318．
29 Cohen BE Beneficeal effect of saged division of pedical in experimental axial---pattern flap. Plast Reconstr Surg, 1979,64;366.
30 Gottrup F, Williams TR, Myers MB, et al. A comparative study of skin blood flow in musculocutaneous and random pattern flaps. J Surg, 1984;73:843.
31 钟德才，陈壁，赵建亚等。真皮下血管网片移植血运重建的实验研究。解放军医学杂志，1983；8；11。
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