| Objective ① Making random flap animal model of the fixed Length to width ratio(4cm:2cm) pedicle carrying the different size flap. Observation in the process of healing flap and the expression of CD34, PI3k, Akt, and NOS in the survival process of slender narrow pedicle flap, to discuss the survival mechanism of the flap; ② Making the extravasated blood flap animal model of the slender narrow pedicle flap. Application of pressure difference technology to improve the slender narrow pedicle flap blood supply, to discuss ways to promote slender narrow pedicle flap survival; ③ And clinical applications.Methods ① basic experiment part 1:Making the fixed Length to width ratio with different area of the animal model of random flap.50 New Zealand white rabbit were randomly divided into 5 groups, each group of 10.The flap pedicle length-width ratio of 4cm:2cm, each carrying five different size flap, diameter of 4 cm,5 cm,6 cm,7 cm,8 cm respectively, and named A, B, C, D and E respectively. Flap A was control flap of B, C, D and E. In each group, flap A, B, C, D and E were created in each rabbits’bilateral dorsum, and the space between the pedicle and rabbit’s median line was 2cm. For reducing error, the flaps’sequence were randomly arranged. The flaps were evaluated with the general observation, temperature examination, and computerized analysis of survival area in 14 days postoperation. The full-thickness tissue specimen were cut down on the edge of each flap’s remote, which size was long (0.2cm) × width (0.2cm), at days 0,1,3,5,7, and 14 after operation respectively. By HE staining, tissue microarray, immunohistochemical, enzyme-linked immunosorbent (ELISA) techniques, and so on,for the qualitative and quantitative analysis of CD34、PI3k、Akt、NOS in the flap. ② basic experiment part 2: Making the extravasated blood flap animal model of the slender narrow pedicle flap. The flap pedicle length-width ratio of 4cm:2cm, each carrying diameter of 8cm size flap.The slender narrow pedicle flaps were created in each rabbit s’bilateral dorsum of 20 New Zealand white rabbit, and the space between the pedicle and rabbit’s median line was 2cm. For reducing error, the flaps’sequence were randomly arranged. Application of pressure difference technology on one side of the flap (experimental group), Application of package on the other side of the flap(control group). The flaps were evaluated with the general observation, and computerized analysis of survival area in 14 days postoperation. The full-thickness tissue specimen were cut down on the edge of each flap’s remote, which size was long (0.2cm) × width (0.2cm), at days 3,5,7, and 14 after operation respectively. By HE staining, for Observation the change of the flap tissue in different time. ③ clinical application:Collect all sorts of reasons caused by skin and soft tissure defects which can be repaired by the slender narrow pedicle flap of 50 cases.Results ① When the ratio of the length to width of the slender narrow pedicle was 4cm:2cm, along with the flap area increased, the flap survival area also increased, but when the flap reached diameter of 8 cm, the distal flap would necrosis; ② Histological analysis showed that, because of intraoperative tissual lesion,the reaction of the hypoxia and ischemia,the expression of CD34、PI3k、Akt、NOS increased; reached the plateau level at days 5、3、3、3 after operation respectively, and decreased to normal level after 14days. ③ Application of pressure difference technology can promote the slender narrow pedicle flap survival, between groups of experimental side than control side flap significantly reduce swelling, edema degree and the congestion situation of side improved significantly than control. ④ The slender narrow pedicle flap is an ideal method for repairing the large soft tissue defect.Conclusions ① A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flap size or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis. ② CD34、PI3、Akt、NOS play important role in the survival process of the slender pedicle flap. ③ Application of pressure difference technology can promote the slender narrow pedicle flap survival. ④ The slender narrow pedicle flap is an ideal method for repairing the large soft tissue defect. |
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