The Experimental Study Of Applicatiaon Of Per Cutem Oxygen Partial Pressure In Perforationg Branch Skin Flap

Background The conception of perforator flaps came of the later period of 1980s. The pioneer were Kojima,Kroll,Wei,Kimura,Blondeel,et al.The clinical applications of perforator flaps have been widespread increasingly after they were used by Gu YD in 1985 in china.But the distal end of the flap were necrotized frequently casued by disturbance of blood circulaton.The wound was repaired by the distal end of the pedicled perforator flap.The proximal end of the pedicled perforator flap is void for the wound repair.It is abortive when the distal end of the flap were necrotized after the operation. Nowadays, Many research upon on the reason of leading to the necrosis of skin flap. And now , we observe the blood circulation of flap major through observing color of skin,the reflection time of blood capillary cranial nerves subjective index. This experiment to have a foothold somewhere of the advanced equipment PeriFlux 5000 system, using transcutaneous oxygen tension measurement die-block, and erecting a animal model, in this model ,the flap must has necrosis region, and dividing the flap to four regions.In this time you must protect cutaneous branches,then we can monitoring the flap using the equipment. So we can find the blood circulation changing regularity when the flap necrosis, meanwhile provid a objective method for observing the flap blood circulation in clinic.Objectives Observing the rule of transcutaneous oxygen tension measurement in the course of flap distal end necrosisMethods1. Lead oxide suspending liquid injection technique.We tested the sedimentation rate of lead oxide suspending liquid of different concentration in fluoroscopy. We radiographed and anatomized the arteries after Wistar rats were perfused with the perfusate.2. Anatomic character for animal model.We establish the distal necrosis of perforator flaps on the back of 100 male Wistar rats (each about 400 grams)with the same size but inconsistencies with the necrotic ramovals Pedicled with the cutaneous branches of iliolumbar artery, make the rat's dorsal midline as its medial boundary ,the spine of the 2nd thoracic vertebra as anterior boundary, the spine of the 2nd cervical vertebra as posterior boundary。The lateral boundary is designed by the aspect ratio of 6:1 Divide the flap into 4 regions from proximal to distal ,harvest the flap and suture the skin. Then get the measurement of oxygen partial pressure of the 3 different points in each region at the day of 0,1^st 2^nd 4^th 7^th after the surgery3.The method of observing necrosis in distal end after surgery We can observe the flap through wether or nor the flap has water thesaurismosis and erythema.Then it can divla no water thesaurismosis, light water thesaurismosis(reluctance to see), midrange water thesaurismosis(obviously uplift), Severe edema(the skin uplift in lmm,and it circumsciption clearance), Severe uplift (the skin uplift out 1 mm and it has expansion) by wether or not it has water thesaurismosis;It can also dival no erythema, light erythema(reluctance to see), midrange erythema(obviously to see), Severe erythema, prunosus erythema to light escharosis.Through the two aspects synthesize whether or not the flap take,we observe when the flap develops severe edema and midrange erythema,then the flap necroseResults1. Lead oxide suspending liquid injection technique.The perfusate was prepared as follow: 50ml of water was added to 100 grams of red lead oxide. All the arteries were developed clearly under the X-rays, and the figure were plump.2. Anatomic character for animal model.From crista nuchalis to ischium tuberocity, the six pair of cutaneous branches in rats' back locate in the two side of vertebral column symmetrically.They were posterior auricular a. &v., anterior scapular a.&v., dorsalis branche of lateral thoracic cutaneous a.&v.. dorsalis branche of subcostal a.&v., iliolumbar cutaneous a.&v., inferior gluteal cutaneous a.&v..Variance existed in the dorsalis branche of lateral thoracic cutaneous a..3. In the 100 rats,9 rats dead,and 7 rats the cutaneous branches were cut leading the operation to defeat;three rats' flap necrosis region justo major, 16rats' flap necrosis region justo minor,so 35 rats have no use,then remaining 65 rats have statistics use.The cellular necrosis condition of skin flap:The four region necrosis by degrees,and the value of partial pressure of oxygen degrade gradually,in the four day of the surgery,the numerical datas have no sense;the three region has some part to death,the others' blood circulation improve by degrees; the one region's and two region's blood circulation improve by degree, water thesaurismosis disappear, the value of partial pressure of oxygen improve by degree,on the seven day of the surgery recovery elementary.After the operation the four region occur little edema,then finding cyanose quikly,then appearing erythema one day late,then to prunosus erythema two day late,then to eschar four day later.the three region's little eare appear erythema two day later,the to prunosus erythema four day later,and then to eschar seven day later. Analying the variability of Preoperatipn and postoperation through statistics method,postoperation has a obviously defeat than preoperation,but has no variability in peroperation.But posroperation the four regions have obviously variability in one day and two day.then we can find the two region obviously topper than the one region,and the two region,the three region,the four region have decrement tendency;if we compare the four region and the seven day,the one region and the two region have no variability,but the two region,the three region,the four region present decrement tendency.Comparing all time points of every regions,we can find the one region,the two region,the three region present obviously upgrade tendency,and the four region present decrement tendency. Statisticsanalysis the P numerus smaller than 0.05ConclusionsRranscutaneous oxygen tension measurement can accur anticipat whether the flap can vivil or whether one part of the flap can vivil.And it can continuous monitoring the flap.