An Investigation of Lymphatic Function Following Free‐Tissue Transfer
An Investigation of Lymphatic Function Following Free‐Tissue Transfer
复制标题
游离组织移植后淋巴功能的研究
DOI：
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发表时间：
1997
影响因子：
3.6
通讯作者：
A. D. Van den Abbeele
中科院分区：
文献类型：
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作者：
S. Slavin;J. Upton;William D. Kaplan;A. D. Van den Abbeele
患者;尽管显微外科在修复被切断的动脉、静脉和神经方面取得了进展，但在再植过程中，通常无法识别或重新连接被破坏的淋巴管。虽然移植部分的暂时肿胀归因于淋巴水肿，但这种情况无需显微手术干预即可解决。淋巴的自发再生或重新连接被认为发生在这种情况下。显微外科自由皮瓣转移在临床上类似于再植，因为它也导致所有离开皮瓣的淋巴通道完全分裂。皮瓣重建后淋巴的再生能力，无论是带蒂的还是游离的，很少受到关注，因为目前还没有安全准确的技术来观察和评估这些结构的状态。由于放射性胶体淋巴显像技术的最新进展，可以从生理、解剖和无创的方式来证明淋巴流动。这些方法可以应用于自由皮瓣模型，以记录手术治疗后的淋巴功能，并确定这种生长过程何时以及在多大程度上发生。我们研究了连续10例进行游离皮瓣重建的患者。这些皮瓣用于慢性骨髓炎(6)和不稳定的伤口覆盖(4)。使用的微血管皮瓣包括背阔肌、肩胛-肩胛旁皮肤筋膜、侧臂、腹直肌、颞顶骨和游离脚趾。所有患者直接注射游离皮瓣真皮，用三硫化锝- 99m -锑胶体（Sb2S3）进行放射性胶体淋巴显影。所有患者在游离皮瓣移植后8 - 44天（平均23.6天）进行研究。在每个皮瓣注射后，所有患者都观察到放射性示踪剂沿淋巴通路快速排出，并进展到局部区域淋巴结。通过放射性核素淋巴显像技术，对连续10例肢体创伤重建患者进行了微血管游离组织移植后淋巴通路的重建。(塑料。Reconstr。外科杂志99:730,1997。)
&NA; Despite microsurgical advances in the repair of severed arteries, veins, and nerves, disrupted lymphatics are not usually identified or reconnected during replantation. Although temporary swelling of a replanted part is attributed to lymphedema, this condition resolves without microsurgical intervention. Spontaneous regeneration or reconnection of lymphatics is thought to occur in such situations. Microsurgical free‐flap transfer is clinically analogous to replantation in that it also results in a complete division of all lymphatic channels exiting the flap. The ability of lymphatics to regenerate after flap reconstruction, either pedicled or free, has received little attention because safe and accurate techniques for visualization and evaluation of the status of these structures have not been available. As a result of recent advances in radiocolloid lymphoscintigraphic imaging techniques, it is possible to demonstrate lymphatic flow in a physiologic, anatomic, and noninvasive manner. These methods can be applied to free‐flap models to document lymphatic function after surgical treatment and determine when and to what extent such a process of growth occurs. We studied 10 consecutive patients having free‐flap reconstruction. These flaps were performed for chronic osteomyelitis (6) and unstable wound coverage (4). Microvascular flaps used were latissimus dorsi, scapularparascapular fasciocutaneous, lateral arm, rectus abdominis, temporoparietal, and free toe. Radiocolloid lymphoscintigraphy with technetium‐99m‐antimony trisulfide colloid (Sb2S3) was done on all patients by injection directly into the free‐flap dermis. All patients were studied between 8 and 44 days (mean 23.6) after free‐flap transfer. Following injection into each flap, rapid egress of the radiotracer along lymphatic pathways with progression to locoregional nodes was observed in all patients. Reestablishment of lymphatic pathways following microvascular free‐tissue transfer was demonstrated by radionuclide lymphoscintigraphic techniques in 10 consecutive patients who had reconstruction for extremity wounds. (Plast. Reconstr. Surg. 99: 730, 1997.)