| Objective To investigate the effect of skin tissue expansion on the perforator flap in morphology and the diameter of the perforator vessel and to establish a new operative method to repair large scars of forearm and hand with the expanded deep inferior epigastric perforator flaps.Methods The experiment was accomplished in the Molecular organism Laboratory of Anhui Medical University and the Surgical Experimental Animal Center of the First Affiliated Hospital from March to October, 2009.Twenty adult New Zealand rabbits were used as experimental animals,which were allocated into expansion and unexpansion groups.After anesthesia of ear vein injection,all animals prone position fixed,back shaving,explored the distribution of perforator vessel in the rabbit dorsal midlin on both sides with supersonic Doppler.The perforator vessel were chosen as axes vessels to design flaps in both groups. Incisions of about 4-5 cm were made outside the dilated regions. Blunt and sharp dissections were performed up to 2 cm outside of perforator point under the deep fascia layers at marked regions (avoiding damage to the perforator vessels). Electric coagulation hemostasis was applied to active hemorrhage sites. After the expander was checked for damage or leakage, it was placed in lacuna that had finished peeling and had spread fully. The catheter and injection port were then sutured and fixed subcutaneously. One week after surgery, we began to gradually inject water into the expander 2-3 times each week 10 to 20 percent each time. In total, injection was carried out for one month or so.Surgery for pedicle division was carried out after one month,The cutting flap was evaluated after operation,The changes of microstructure in expanded skin were observed with electroscope.There are 20 cases of randomly selected adults, who explored the distribution of perforator vessel with supersonic Doppler. And there are 18 case with the pre-expanded deep inferior perforator flap in abdomen, CTA inspection was performed to compare the variations in the diameters of the perforator vessels and the expanded perforator flap were transfered to repair the defects of forearm and hand.Results To establish the dilated perforator flap,after expansion the perforator vessel thicker under the naked eye,HE staining showed the average flap diameter and thicker ( 38.2±2.3 ) % than the unexpansion group,and the dermal layer of dilated thinning,granulation tissue,blood vessel cross-section become richer,less inflammatory cell infiltration,the new capillaries are increaser.There are 425 emission points in all.There are some regularitys of the distribution of these emission point. We repaired the forearm or hand scars with this method in all 20 cases.Among them,there were 1 case which have appeared blood barrier in the distance of the flap,In another 17 cases the flaps were completely successful and have satisfactory appearances and functions.Conclusion After expansion the perforator flap become thicker,capillaries proliferated and blood get rich.The expanded deep inferior epigastric flap is a kind of technique with good blood supply,large area and suitable flap thickness.The skin colour,its quality nature and sense are matched with forearm and hand. It is an effective and practical approach to resconstruct the large forearm or hand scars. |
