The Study Of Experiment To Prevent And Treat Congested Flap And Clinical Application

Objective:To explore a new method to prevent and treat congested flap during operation, from study the mechanism the of application Vacuum Sealing Drainage early to affect congested flap.Method:experiment:112SD rats were divided into7groups in random. A flap was designed and put on either side of a rat’s back, and the flaps on one side of the rats’backs were randomly arranged into control group, and the flaps on the other side served as the experiment group. The local flap was designed in the shape of a tennis racket. The width and the length of the flap were both0.8cm and the diameter of the pedicle was3.5cm.7groups were defined depended on the duration of the experiment:one hour, four hours, one day, two days, three days, four and seven days. One group had no vacuum sealing drainage. For each groups there was a control group. The equipment of vacuum sealing drainage was fixed sideways after the shaping of flaps in each group. Each of the equipments in the groups was dismantled instantly after one hour, four hours, one day, two days, three days, four days and seven days respectively after the operation. Afterwards the color and swelling degree of the flaps were checked, a sample with the size of0.3cmx0.5cm was cut, and the flap survival area was measured on the seventh day post operative. The expressions of HIF-1a, vascular endothelial cell and microthrombus of the flap were observed mainly through HE dyeing and immunohistochemistry. Clinical application:The long and narrow pedicle congestive flap was designed with "reversing method" according to the position and the size of the defect on the conceal position or well-being tissue away from the defect. Drainage strips are placed which come from half of the drainage tube (length wise) bellow flap after repairing the tissue defect, and the drainage looks like semicircle, and vacuum sealing drainage was placed over the flap and donor size, then aspirate blood detaining in flap and bellow flap on negative pressure initiatively and alternatively from130kp (3hours) to300kp (0.5hour). Vacuum sealing drainage was dismantled after3days, and then drainages were pulled out.Results:Part of animal experiment:Firstly, the damage of vascular endothelial cell and microthrombus in the experiment group of flaps is less than the control group of flaps in the same time in the experiment group of flaps, so as the expression of HIF-1a, and the trend of expression of HIF-1a does not rise obviously in the fore3days, and rises obviously from the4days; but in the control group of flaps, when time-lapse, the expression of HIF-1a increased, reached the plateau level after5days of HIF-1a. Secondly, the congestion of side flaps under experiment were obviously mitigated compared with those under control, and VSD can promote the survival of flap, and the survival area will be the largest on the third day. part of clinical application:27cases were treated, and part tissue of the distal end of flap was dead because of pressure on one patient which suffers from paraplegia, and the other flaps survived with good texture, elasticity and color.Conclusions:The application of vacuum sealing drainage early to venous-congested flap can rebuild collateral circulation which was not physiological, and can aspirate detained blood initiatively, and weaken the ischemic and hypoxic tissue of flaps, and lessen the damage of vascular endothelial cell and the formation of microthrombus of flap, and be good for the survival of flap. It is easily performed and very practical to prevent or lessen congested flap.