The Experimental Study And Clinical Application Of The Prefabricated Skin Flap With Vascular Implantation

Object: To study the morphologic transformation of the implanted vessel and the trend of the skin flap revascularization during the formation of the prefabricated skin flap, to learn the mature time of the prefabricated skin flap, and combined with the study and research of predecessors to infer the mechanism of the prefabricated skin flap formation. Clinically, to study the feasibility of the facial defect reconstruction using prefabricated and expanded cervical skin flap with superficial temporal vessel as pedicle, to study the specific operation method and the operation effect evaluation.Method: The experiment was divided into two parts. First, using Meglumine Diatrizoate Angiography X ray photographic method, dynamically observe the morphologic transformation after the vessel transplantation. Second, using histological inspection and stereology methods, dynamically observe the total changing trend of the prefabricated skin flap vascularization. In clinic, transfer the superficial temporal vessel through the under skin tunnel to the cervical skin flap and implant an expander at the same time. By the prefabricated skin flap revascularization and the skin expanding, the islandlike expanded skin flap was formed to repair the large facial skin and soft tissue defect. 18 clinical cases were studied by retrospective methods.Result: 1. Angiography experiments show that after implantation into the skin flap the blood vessel grows dendriform. Vascularization takes place at distal end of the implanted blood vessel. There has not been observed the blood vessel formation at the trunk or the proximal site. 2. Morphologic transformation of the implanted vessel changes dramatically in the first 3 weeks, from then on the changes become not so obvious. 3. While the prefabricated skin flap formation, the total blood supply of the skin flap changes in a process of first reducing then gradually increasing, at last resumes to the degree of the original skin flap. 4. In clinic, complete 18 facial defect repairing operations using prefabricated and expanded cervical skin flap with superfacial temporal vessel as pedicel. In the 18 cases, only 1 case showed skin flap contracture in earlier stage and the lower eyelid valgus, another case showed partial necrotic at the distal end of the skin flap. All of the last 16 cases acquired good operation effect. Summarize experiences, and formulate consummate modus operandi.Conclusion: 1. Revascularization takes place at distal of the implanted blood vessel, not at the trunk or the proximal end. 2. The mature time of the prefabricated skin flap is about three weeks after vessel implantation. 3. The blood supply of the prefabricated skin flap reduces at first, and then increases, which imply the mechanism of the prefabricated skin flap formation is that the blood supply network of the original skin flap destroyes at first, accompanying with reduction of blood flow; in order to maintain the internal environment steady state, the new blood network supplied by the newly implanted vessel gradually takes the place of the skin flap blood supply, at last reaches a balance of the blood demand and supply. 4. The clinic application of 18 cases validates the prefabrication method, which implies its value to promote to a wide use. From clinic application, we conclude a serial of key points, including surgical indication and patient selection, the specific surgical operation method, the alerting notes in the operation, the prevention and treatment of postoperative complications.