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Background The concept of skin flaps from the 20th century in the late 1980s, Kojima, Kroll, Wei, Kimura, Blondeel and so is the pioneer in this area representative. Skin flap has been carried out in our country, the increasing number of clinical applications. However, postoperative blood circulation disorder caused by all or part of the flap (distal) necrosis have occurred. Pedicled skin flap transfer often is the use of distal flap to cover the wound, proximal flap pedicle longer valid, so the whole flap necrosis or necrosis of the distal portion means that surgical failure. Most of the research that led to the main cause of skin flap necrosis research, and clinical observation flap blood supply mainly to observe the skin color, capillary reaction time, and other subjective indicators to measure the tension in this experiment is mainly based on the sections of the advanced instruments PeriFlux 5000 systems, applying its transcutaneous oxygen measurement module, the establishment of an animal model, in this model the flap on the requirement to have a constant necrotic area, and then the flap is divided into four regions, protection Good cutaneous branch, and then apply the continuous monitoring of the machine. In order to identify when the flap necrosis blood supply variation, as well as clinical observation flap blood supply to provide an objective way. Objective To observe the distal flap necrosis process, the entire flap transcutaneous oxygen pressure variation. Method 1. Anatomical basis of animal models: the use of latex perfusion through the ascending aorta on 10 rats were perfused and dissected while dissecting 20 rats in vivo were observed cutaneous blood vessels line the back of the law, variation and measurement The basic anatomical data. 2 Animal experiments: the 100 male Wistar rats (400g or so) on its back flap distal cutaneous necrosis establish an animal model (the same size flap necrosis, necrosis inconsistent removal). Iliac artery with lumbar skin pedicle flap in the rat dorsal midline of the inside flap of bounds to the horizontal line of the second thoracic spinous anterior border of the flap to rat second sacral spinous The horizontal line of the rear boundary, the outer boundary aspect ratio of 5:1 according to design, from the proximal to the distal flap were divided into four regions, cut around the ring strongly SAGE slow broom broom ridiculed Jing dilute H Slow salt? surgery immediately), after one day, after two days, after four days, after 7 days were measured in each region in three different points of transcutaneous oxygen pressure value, and then averaged to obtain the oxygen partial pressure value of each region were analyzed. 3 distal flap necrosis observation methods in accordance with the presence or absence of edema and skin erythema two aspects to observe. Which can be divided according to whether the edema edema, mild edema (barely visible), moderate edema (significant uplift), severe edema (skin bulge 1mm or less, outline clear), severe uplift (uplift the skin and has expanded more than 1mm) ; can be divided according to whether no erythema erythema, mild erythema (barely visible), moderate erythema (visible), severe erythema, erythema to slight eschar purple form. The two aspects are combined with comprehensive assessment of flap survival, through this experiment, the authors observed edema associated with moderate to severe erythema skin flap necrosis. Results 1 rat vascular anatomy back back of rats from crest to the ischial tuberosity items symmetrically distributed on both sides of the spine has six pairs of cutaneous blood vessels: the ear vein, anterior cutaneous scapular artery and vein, lateral thoracic vein dorsal skin branches, dorsal cutaneous branch arteriovenous ribs, iliac arteriovenous leather waist, inferior gluteal artery and vein. Which ribs artery dorsal cutaneous branch of some variation. (2) According to rat animal model of cutaneous vascular anatomy of the back of the results, the election to the iliac artery leather lumbar pedicle flap inside the boundary of dorsal midline anterior border of the second thoracic spinous process, the latter sector is the second sacral spinous process, the outer boundary in accordance with an aspect ratio of 5:1 flap design. 3 100 animals have nine rats during anesthesia in many accidental deaths, there are seven during surgery, cutaneous accidentally cut off leading to surgical failure, there are three large range of flap necrosis, 16 only flap necrosis range is too small, a total of 35 mice were removed, and the remaining 65 mice in the size range of necrosis statistically significant confidence intervals. Flap necrosis: after 4 zone is gradually necrosis, PO2 decreased gradually after the fourth day of the measured data has no meaning; 3 zones in some areas after the gradual necrosis, other regional blood flow gradually improved; a , two areas gradually improved blood circulation, edema disappeared, PO2 increased gradually after the first seven days returned to normal. Using statistical methods (spssl3.0 software) for analysis, preoperative no difference between the various regions, significantly lower than before surgery after surgery. But after one day, two days testing, there are obvious differences of each region, in which zone 1 and zone 2 Comparing two areas was significantly higher than 1 and Zone 2, Zone 3, Zone 4 is greater difference between before and after, and showed significant decreasing trend; after four days, after 7 days compared between regions, between 1 and zone 2 zone difference greater than 0.05,2 area, Zone 3, Zone 4 are still differences between the comparison more obvious, and showing a decreasing trend. The same area at different time points compared to a Zone 2, Zone 3 showed a clear upward trend, four area showed a significant downward trend, statistical analyzes were less than 0.05. Conclusion: transcutaneous oxygen can accurately predict flap or flaps whether a certain part of survival. And can be applied transcutaneous oxygen pressure for continuous monitoring of the entire flap
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