摘要
目的探讨逆行吻合神经法重建皮瓣感觉的可行性。方法选择豚鼠100只,随机分为4组:逆行吻合神经组(A组,30只)、顺行吻合神经组(B组,30只)、未吻合神经组(C组,30只)及正常组(D组,10只)。分别在A、B、C组各豚鼠左后肢切取隐神经营养血管皮瓣,A组在皮瓣近远端切断隐神经,皮瓣远端隐神经与近断端近侧吻合;B组在皮瓣近端切断隐神经再予以吻合;C组切除一长约1.5cm皮瓣近端隐神经。A、B、C组在术后第1、2、3月末前2周切开皮缘并向中心游离,原位缝合皮肤。术后1、2、3个月各组任选10只豚鼠,A、B、C组原位切取皮瓣,1个月时,D组直接切取皮瓣,离体皮瓣行抗神经丝抗体免疫组化法检测,观察皮瓣内原神经纤维及神经末梢再生情况。结果 A组与B组相似,术后1个月,神经吻合远侧可见再生神经纤维,密度较D组低,术后2个月,皮瓣内整段神经可见再生神经纤维,并以神经为中心,真皮层形成神经网丛,表皮下形成游离神经末梢及毛囊感受器,术后3个月,上述再生神经组织与D组皮肤神经组织密度相仿。C组全程未见神经纤维再生。结论逆行吻合神经法通过中央途径机制,能使皮瓣恢复良好感觉。
Objective To investigate the feasibility of retrograde nerve anastomosis for reconstructing flap sensory function.Methods A total of 100 guinea pigs were selected and randomly divided into 4 groups:retrograde nerve anastomosis group(group A,n=30),anterograde nerve anastomosis group(group B,n=30),non-anastomotic nerve group(group C,n=30)and normal group(group D,n=10).Saphenous neurocutaneous vascular flaps were cut off from the left hind limbs of guinea pigs in the group A,B and C.For group A,the saphenous nerve at proximal and distal flap was cut off,and the distal saphenous nerve of the flap was anastomosed to that of the proximal side;for group B,the saphenous nerve at proximal end of the flap was disconnected and then anastomosis was carried out;for group C,a section of saphenous nerve at proximal end of the flap with length of about 1.5 cm was cut off.For group A,B and C,the skin edge was cut and dissociated towards the center,and then the skin was sutured in situ at 2 weeks of the end of postoperative 1,2 and 3 months.At the end of 1,2 and 3 months after surgery,10 guinea pigs were randomly selected from each group respectively.For group A,B and C,the flaps were cut in situ.For group D,the flaps were cut directly at the end of the first month.The immunohistochemistry was used to detect anti-neurofilament antibodies in the isolated flaps for observing the regeneration situation of original nerve fibers and nerve endings inside the flaps.Results The group A was similar to the group B.In the first month after surgery,the regenerated nerve fibers could be seen at the distal side of the neural anastomosis,and the density was lower than that in the group D.In 2 months after surgery,the regenerated nerve fibers could be seen in the whole section of nerve inside the flap.Meanwhile,the nerve served as the center,the nerve net plexus was formed in dermis layer,and the free nerve endings and hair follicle receptors were formed underneath the epidermis.In 3 months after surgery,the density of the above-mentioned regenerated nerve tissues was similar to that of skin nervous tissue in the group D.The nerve fiber regeneration was not seen during the whole process in the group C.Conclusion Retrograde nerve anastomosis could make the flaps recover good sense via central channel mechanism.
作者
余晓军
陈雪松
徐永清
王晓凤
吉丽
刘亚
YU Xiaojun;CHEN Xuesong;XU Yongqing;WANG Xiaofeng;JI Li;LIU Ya(Department of Traumatic Microsurgery,59 Central Hospital of PLA,Kaiyuan,Yunnan 661699,China;Orthopedic Center of PLA,Kunming GeneralHospital of PLA,Kunming,Yunnan 650000,China)
出处
《重庆医学》
CAS
2018年第34期4349-4353,共5页
Chongqing medicine
关键词
逆行吻合神经
皮瓣
感觉重建
实验研究
retrograde nerve anastomosis
flap
sensory reconstruction
experimental study
