Clinical Application Of Perforator Fasciocutaneous Flap

Background:Local perforating flap transplantation is often used to repair skin and soft tissue defects,because it has sufficient tissue content,skin color,texture and the skin closer to the affected area.Survival rate is the most concerned issue in clinical application,mainly depends on the blood supply of local perforating flap,which is the establishment of flap microcirculation.In order to further compare the survival rate of the perforator fascia flap and the perforator flap,this experiment intends to establish an animal model by using the posterior intercostal artery(PIA)of SD rats as a perforator.Answer questions based on local anatomy,histology,immunohistochemistry,and tissue protein levels.Objective:(1)By establishing a SD rat model of perforating fascia pedicle flap and perforating flap,the survival rates of the two flaps were compared,and the effect of completely removing the perforator fascia on the survival of the flap was explored.(2)combined with the experimental study of perforating fascia pedicle flap,using the finger-inherent artery perforator flap for the treatment of clinical finger flexion contracture deformity,and to explore and summarize the clinical therapeutic effect of local perforator fascia flap feasibility.Methods:(1)Animal experimental study: 50 SD rats were taken,male or female,and randomly divided into 2 groups,25 in each group.Group A was a perforating fascia pedicle flap group,and group B was a perforated pedicle flap group.The local in situ flap was designed with the right intercostal artery perforator as the pedicle on the back of SD rats.The size of the flap was 10.0cm*2.5cm.Group A retained the perforator andits surrounding fascia tissue of 10.0cm*2.5cm.In group B,only the perforating branches were retained,and the fascia tissue around the perforating branches was removed as much as possible.The survival rate of the flaps was observed and compared,and the survival rate of the flaps was calculated.The angiogenesis of 50 specimens of the perforator flap was measured,and the average vessel density,mean vessel diameter and mean vessel wall thickness were analyzed.Immunohistochemistry was applied.The method was to observe the difference of hypoxia inducible factor-1?(HIF-1?)and cytoglobin(CYGB)expression in the two groups of flaps under the microscope;by immunoblotting,Hypoxia inducible factor-1?(HIF-1?)and cell line protein(Cytoglobin,CYGB)were quantitatively determined in the two groups of flaps and the differences between the two groups were compared.(2)Refers to the clinical application of local perforating fascia pedicle flap: based on the experimental study,14 cases of flexion contracture of the local fascia pedicle flap with internal artery perforating vessel were designed.The area of ??the flap donor area was 1.4×2.0.~1.8×2.5 cm.Results and Conclusion :(1)The survival rate of flaps in group A and group B was compared(P<0.05).The neovascularization was observed by HE staining.The vascular density,vessel diameter and vessel wall thickness of group A were higher than those of group B(P<0.05).Immunohistochemistry and Western blotting results showed that HIF-1a was higher in group B than in group A,and CYGB was higher in group A than in group B,and the peak appeared earlier.HIF-1? promotes healing of the flap within a certain amount,and excessive inhibition;CYGB may simultaneously promote flap angiogenesis and promote flap wound healing.(2)Refers to the natural artery perforator flap can effectively repair the mild to moderate flexion contracture of the fingers,with the advantages of simple flap removal,easy operation,small wound surface and satisfactory postoperative recovery.