ABSTRACT
Objective To investigate the application and survival mechanism of a long and narrow pedicle flap which was used to repair the tissue defects after removal of tumor in aged patients.Methods The long and narrow pedicle flap was designed with its pedicle located beside wound surface along the pathway of well-known or perforating branch blood vessel to repair the defect caused by removing the tumor in aged patients.The size of the flaps ranged from 3 cm × 4 cm to 10 cm × 12 cm.The length and width of the pedicle ranged 2 - 8 cm and 1.0 - 1.5 cm.Results This flap was used in 17 cases.The flap was survived well in 14 patients,and healed later in other 3 patients because of wrong bandaging in earlier period.Conclusions The capability of bearing ischemia and hypoxia of the flap tissue is stronger after transfer owing to low metabolic rate in the skin tissue in aged patients.The flap is easily survived by repairing the tissue defects after removal of tumors in aged patients with the long and narrow pedicle flap.The pedicle of flap is narrow and long,and the transposition of the narrow pedicle flap is easy.The postoperative appearance is satisfactory.It is an ideal choice for repairing the defect caused by removal of tumor in aged patients.
ABSTRACT
Objective To reveal the relationship between NOS,CD34 expression and the flap survival area,and to explore the survival mechanism of narrow strip flap,by designing different skin flaps with a slender narrow pedicle in a certain proportion of length to width on pigs' backs.Methods Five narrow flaps were formed on each side of the five white domestic pigs' back,of which pedicle width length ratio were 2 cm:4 cm,the area of the flaps was 2 cm × 2 cm,3 cm × 3 cm,4 cm ×4 cm,5 cm × 5 cm,and 6 cm × 6 cm,respectively,and named as flaps A,B,C,D,and E in turn.Besides,the flap A was taken as control.After the operation,the flaps were evaluated with general obveration,and NOS and CD34 expression and survival area were analyzed.Results For groups A,B and C flaps,the expression level of NOS and CD34 gradually elevated as the flap increased in size,and flaps completely survived (P＜0.05) ; For flaps in groups D and E,when distal end of flap was partial necrosis,the expression level of NOS and CD34 no longer elevated with the increase of skin flap area,and their expression was relatively constant (P＞0.05).Conclusions The survival area of the skin flaps is not in proportion to the width of its pedicle.Thus there is a maximum survival area of a skin flap carried by slender narrow pedicle in a certain proportion of length to width.
ABSTRACT
Objective To detect the expression of SDF-1 and CD34,and MVD changes at slen der narrow pedicle flap of hypoxia and ischemia during the survival process,and to investigate the role of SDF-1 at flap neovascularization.Methods The slender narrow pedicle flaps,which pedicle's length-breadth ratio were 4 ∶ 2,and the flap size of each took an area of 2 cm × 2 cm (group A),3 cm ×3 cm (group B),4 cm × 4 cm (group C),5 cm × 5 cm (group D) and 6 cm × 6 cm (group E),were designed and elevated on each pigs' double dorsum.The flaps were served as a hypoxia/ischemia flap model.The survival area,histologic analysis,SDF-1 and CD34 enzyme-linked immunosorbent assay at the distal flap were evaluated at days 0,3,5,7,and 14 after operation,respectively.Results In the each group of flaps,the expression of SDF-1,CD34 and MVD increased with time,reached the plateau level after 5 days (maximal values of SDF-1:124.80 ± 4.05 ingroup A,137.85 ±3.03 in group B,166.53 ± 2.98 in group C,72.80 ± 2.63 in group D and 62.79 ± 2.20 in group E),7 days ( maximal values of CD34:16.76 ± 0.62,17.60 ± 0.72,18.48 ± 0.55,12.70 ± 0.60,and 11.51 ± 0.70,each group),and 7 days (maximal values of MVD:52.45 ± 2.78,59.34 ± 3.12,61.14 ± 3.35,25.25 ± 3.78,and 24.46 ± 7.46,each group),and then gradually decreased.In the different groups of flaps,when the flap area increased,the expression of SDF-1,CD34 and MVD increased,but the parameters decreased at the area of 5 cm × 5 cm,and the flaps were partial necrosis.Conclusions SDF-1 may play an adjusted role in the survival process of the slender narrow pedicle flap.