| Background:Skin flap transplantation is one of the most basic, the most common treatment in plastic surgery. Vascular crisis after operation, especially the venous congestion, has always been a thorny problem for the plastic surgeon. Current methods to improve flap venous congestion clinically include the use of a variety of anticoagulant and thrombolytic drugs, medical leeches, hyperbaric oxygen, a small incision bleeding and the cell and gene therapy proposed recently. Even taking a variety of methods, there is still inevitably encounter flap part or total necrosis due to venous congestion. Negative pressure wound therapy is one method proposed to deal with complex wounds and deep drainage in the past two decades, which can achieve satisfactory results when its application to the treatment of skin flap necrosis wounds caused by venous congestion. Microneedles can create micron channels in the skin for drug delivery, which only puncture the depth of the stratum corneum, without touching the nerve endings. The possibility of using multiple channels created by microneedle, combining effect of negative pressure, to improve the microcirculation of venous congestion flap, thus improving the survival rate of the flap, is rarely reported in the current study.Objectives:1. To observe the symmetry and the distribution of major veins and arteries, providing anatomical basis for rabbit ear flaps as animal models by making a system and in-depth research of rabbit ear vascular,2. To establishing a stable, self-control venous congestion rabbit ear flaps model.3. Using the self-control venous congestion flaps model to discuss the related mechanisms and therapeutic effect by using wound vacuum therapy devices on venous congestion flaps, exploring a simple and effective way to treat venous congestion flaps.Methods and Results:1. Establishment of the rabbit ears’ vessel casting Methods:Five rabbit skulls were separated, perfusion, corrosion and washing, the bilateral rabbit ears’ vascular casting was established by chemical method, observing the symmetry and the distribution of bilateral rabbit ear arteries and veins. Results:The vascular casting of rabbit ear was established successfully, the major arteriovenous distribute stably, symmetrically.2. Using rabbit ears to establish venous congest flaps Methods:Bilateral ears of 15 rabbits were treated as experimental subjects; a 6X3cm2 flap was designed on each ear. The 15 rabbits were divided into 5 groups according to the width of the pedicle, containing 3cm,2cm, lcm,0.5cm and 0cm group. Each flap retained the ear artery as the only artery, the pedicle skin as the only venous channel. We want to observe the survival rate of flap between the different side of the same rabbit, and the various groups. Results:The survival area of the venous congestion flap was roughly the same between the two ears of one rabbit. There is significant difference between different groups. The group of pedicle width 0.5cm had higher range and probability of forming flap congestion.3. The effect of VAC device on the survival of venous-congested skin flaps in rabbit ear Methods:26 axial-pattern auricular flaps were performed on 13 rabbits (-3kg), both of the two ears of one rabbit to perform the venous-congested skin flaps. The two ears of one rabbit were randomized into VAC therapy group or control group that received no treatment, each group has 13 flaps. The flaps of VAC group were made multiple channels by the microneedle, and using the low molecular heparin to keep channels unobstructed after operation. The duration of VAC treatment was 3 days. The flaps of control group were bound up by 4×4 gauze. The areas of flap survival were measured on postoperative day 7, and specimen was cut at the same location on day 3, to detect the NO, MDA and SOD value, compare the pathology, VEGF immunohistochemical.Results:There was significant difference on flap survival, NO, SOD and MDA value, VEGF immunohistochemical between the two groups, the experimental group was much better than the control group.Conclusion:1. The major arteriovenous of bilateral rabbit ears distribute stably and symmetrically, the survival area of the venous congestion flap was roughly the same between the two ears of one rabbit, which can be used as a model of self-control.2. The animal experiments showed that vacuum sealing device combined with microneedle treatment can significantly increase the expression of VEGF, promote angiogenesis of congest flap, accelerate flap healing, which improve skin flap survival finally. |
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