Shunt-Restricted Arterialized Venous Flaps Mimicking Arterial Flaps in Microcirculation: Observations in Sprague-Dawley Rats

阻斷分流之動脈化靜脈皮瓣可模擬動脈皮瓣之血流：大鼠之微循環觀察

林唯農(Wei-Nung Lin) ； 葉俊廷(Jiun-Ting Yeh) ； 林志鴻(Chih-Hung Lin) ； 魏福全(Fu-Chan Wei) ； 林有德(Yu-Te Lin)

《臺灣整形外科醫學會雜誌》 19卷2期 (2010/06) Pp. 114-122

https://doi.org/10.7096/TJTSPS.201006.0114

摘要

背景：
動脈化靜脈皮瓣並非一種由動脈系統供應營養的正常生理性皮瓣。許多方法曾被提出改善皮辦存活率，但皮瓣靜脈血滯留及皮瓣周邊循環不足的問題常常限制皮瓣在臨床上的應用。
目的與目標：
我們的假設是：以手術式阻斷皮瓣中貫穿動脈血之靜脈血管，不但可以迫使動脈血流繞道而增加周邊血液灌流，亦可降低遠端靜脈管內壓力以利靜脈血排出。本實驗使用大鼠之腹部皮瓣，觀察有無阻斷動靜脈分流對動脈化靜脈皮瓣在微循環上之影響。
材料與方法：
使用六隻雄性大鼠之左側腹部脂肪筋膜皮瓣作微循環的觀察。同一個皮瓣依序觀察在動脈皮瓣、阻斷分流之動脈化靜脈皮瓣、無阻斷分流之穿透血流動脈化靜脈皮瓣時，在100倍放大下微循環之變化。
結果：
在無阻斷分流的動脈化靜脈皮瓣中，整個皮瓣內小靜脈及小動脈中呈現無方向性的緩慢來回血流。在阻斷分流之動脈化靜脈皮瓣，近端皮瓣小血管內的血流呈現緩慢且持續的流動，較大型的血管內呈現間斷性急進急停及朝著皮瓣周邊方向之血流；中段皮瓣內小動脈及小靜脈的血流呈現持續而緩慢由近端皮瓣流向遠端皮瓣；遠端皮瓣內的血流模式則與動脈皮瓣之血流狀態雷同。
結論：
在大鼠腹部脂肪筋膜動脈化靜脈皮瓣的實驗中，我們觀察到阻斷皮瓣中貫穿動脈血之靜脈血管，不但血流仍然可以繞過阻斷處而灌流到皮瓣周邊及遠端，更改變了皮瓣內動靜脈的血流方向，使呈現由近端流向遠端的方向性。

並列摘要

Introduction:
An arterialized venous flap is not a physiologic flap which is nourished through arterial system. Several surgical techniques have been reported to improve the flap survival, but venous congestion and inadequate peripheral perfusion were frequently encountered which limited the generalization of flap. Suzuki ligated the arterialized central vein of the rabbit ear to investigate the influence of the competent ”valve”. They did not extrapolate the mechanism of flap survival.
Aim and objectives:
Our hypothesis is interruption of the flow-through arterialized vein not only makes the arterial flow circumventing the clamp to perfuse the peripheral area but also decreases venous pressure for better drainage. In this study, we conducted a rat experiment to compare the microcirculation of abdominal adipofascial arterialized venous flaps with and without restriction of the arterialized vein.
Materials and methods:
Six male Sprague-Dawley rats were used for microcirculation observation. Each adipofascial flap based on left thoracoepigastric vascular system was prepared and observed following the sequence of arterial flap, shunt-restricted arterialized venous flap, and flow-through arterialized venous flap. Microcirculation was observed and recorded under vital microscope with a 100X-magnification, which is composed of a Nikon microscope MM-22 and a Sony Trinitron video monitor.
Results:
In the flow-through arterialized venous flap, the flow in the flap was slowly to-and-fro in both arterioles and venules without a dominant direction. In the shunt-restricted arterialized venous flaps: at the proximal flap, the flow in the smaller vessels was constant and slow and the flow in the trunk vessels ran swiftly and stopped intermittently towards the periphery of the flap; at the middle flap, the flow moved slowly and constantly from proximal toward distal flap in both arterioles and venules; at the distal flap, the directions of the flow within the arterial and venous networks were similar to the flow observed in an arterial flap.
Conclusion:
In rat abdominal adipofascial arterialized venous flap model, we observed the interruption of arteriovenous shunting not only made the blood flow circumventing the ligated site to nourish distal part of flap, but also made the flow of arterial and venous system of the arterialized venous flap directionally moving from proximal toward distal part of flap.

並列關鍵字

arterialized venous flap ； restriction of arteriovenous shunting ； microcirculation ； venous congestion