6 Application of Arterial Hydraulic Expansion in Tissue Transplantation Fan Cunyi çœ å¹³ 曾 Zeng Bingfang Jiang Peizhu Yu Zhongjia Objective To observe the patency rate and arterial spasm rate of arteries after application of segmental hydraulic expansion during tissue transplantation, and observe through histological study The effect of hydraulic expansion on the structure of the artery. Methods Forty-seven patients with thumb and finger loss were treated with 41 cases of free thumb transplantation, 6 cases with free toe transplantation, and 10 cases with free toe transplantation. After the tissue was completely free, the hepatic arterial + normal saline was injected into the dorsal artery of the foot with a pressure of 300 rnrnHe for segmental hydraulic expansion, and the vascular anastomosis was performed after expansion. After the hydraulic expansion of the dorsal artery of the foot, the pressure was 300 mmHg for histological examination, and the changes of the elastic membrane and smooth muscle in the arterial endothelial cells were observed. Results 1 The skin temperature of transplanted tissue was higher than that of Jianzhi 0.16 after surgery.
2 Immediate patency rate of postoperative blood vessels was 100, and the incidence of arterial spasm was 0.24. One patient developed a crisis due to hematoma compression. After the pressure was relieved, blood circulation recovered. One case failed due to extensive thrombosis of the capillary bed. The success rate of the operation was 98.2.3. The pathological changes of the arterial endothelial cells were 15 shedding, the internal elastic membrane was slightly relaxed, the muscular layer was basically normal, and the thickness was not; An effective method for dilating sputum, as long as the appropriate pressure is applied, the vasodilation is sufficient, and it is safe and effective to reduce the sputum of the arterial vessels and improve the success rate of tissue transplantation. The hydraulic expansion has no significant influence on the structure of the artery wall. Tissue transplantation and intra-arterial; heparin arterial vasospasm is a common phenomenon during and after microsurgery. Stubborn and persistent paralysis not only causes vascular endothelial cell ischemia, but also causes extensive thrombosis of the capillary bed of the transplanted tissue, eventually leading to ischemic necrosis of the transplanted tissue.
In March 2015, in January 2000, we used the pressure of 300 to hydraulically expand the dorsal artery of the foot during the process of finger reconstruction with the reconstruction of the finger flap and the reconstruction of the toe. The ankle of the arterial pedicle during the separation process.
Materials and Methods Fund Project Shanghai Medical Leading Professional Key Subjects 83012 Shanghai Sixth People's Hospital orthopedics This group consists of 57 patients, 44 males and 13 females; aged 16 45 years, mean 26.5 years old. There were 19 cases of left thumb loss, 3 cases of finger loss, 28 cases of right thumb loss, and 7 cases of finger loss. According to the domestic thumb deletion, m thumb A was deleted in 18 cases, B deficiency in 26 cases, and loss in 3 cases. According to the domestic finger defect classification, 225 refers to the absence of 6 cases in 1 case and 4 cases in the area. Forty-one patients underwent reconstruction of the thumb with a free flap, and 6 patients underwent free toe transplantation. The free toe fingers were reconstructed.
According to the conventional method, the dorsal vein of the dorsal vein of the great saphenous vein was firstly dissected, and then the dorsal artery of the dorsal artery of the dorsal artery was free. The posterior dorsal artery of the sacral artery was used. This is a case of the dorsal artery of the iliac artery. In absent, the dorsal sacral artery originates directly from the radial artery. During arterial freeing, all arterial branches are ligated and all soft tissue surrounding the adventitia of the artery is removed until the artery enters the tissue. The end of the lumen is connected to a No. 8 pin, the end is connected to the pressure, and the other end is connected to the syringe. Insert the No. 8 needle into the pedicle of the dorsal artery of the foot, connect the syringe to the 0.9 saline + 12500 shellfish heparin mixture 3, and with 30, 1 yard pressure, the segmentation occurs due to stimulation during the free process. The artery is hydraulically expanded. The operation is blocked with microscopic forceps, and each segment is maintained at 35. After the segment is fully expanded, the lower segment is expanded until the artery enters the tissue bed. Through hydraulic expansion, small branches that are not ligated during the free process can be found and ligated in time to prevent vasospasm caused by persistent bleeding of small branches after vascular anastomosis. If the syringe is visible, the free methylene flap or the toe tissue bed has fluid exudation, and the entire segment of the arteries is fully expanded. Thereafter, according to the conventional method, the bone scaffold was established, the tendon nerve was repaired, and the dorsal artery of the foot and the proximal saphenous artery of the radial artery were anastomosed to the proximal end of the cephalic vein at the nasopharyngeal fossa. The anti-spasmodic antithrombotic resistance was routinely given after operation. Infection treatment.
The histological examination of the dorsal artery of the dorsal artery was performed by placing the normal dorsal artery and the hydrolyzed dorsal artery of the foot in a neutral formalin solution. The water was eluted with transparent water-impregnated wax to form a slice. Dyeing heart stained elastic dyed seals.
Light microscopy The optical microscopy was used to measure the structure and thickness of the elastic layer of the arterial wall in various layers of the arterial wall, especially in the endothelial cells, and to compare the layers of the arterial wall without hydraulic expansion.
Results Among the 57 patients with blood circulation and vascular crisis at different time after operation, 1 patient developed blood circulation disorder after operation. After exploration, it was confirmed to be caused by local hematoma compression. After decompression, blood circulation was restored. Extensive thrombosis of the capillary bed, resulting in necrosis of the transplanted tissue 1. The skin temperature after tissue transplantation is relatively low, 0.42 feet lower than the healthy limb; after that, it gradually rises, after surgery 48 is higher than the healthy side 0.25, and then gradually declines, to the surgery After 120 hours, the skin temperature is 0.17 feet higher than the healthy side.
A total of 49 patients were followed up for 2 months and 4 years, with an average of 2 years and 8 months. The blood circulation of the transplanted tissue was good, and the function and shape were satisfactory.
Histological observation results After hydraulic expansion, the dorsal artery of the dorsal artery had 15 shedding, the internal elastic membrane was slightly relaxed, the muscular layer was basically normal, and the thickness was not 160176. The arterial endothelial cells without hydraulic expansion had 7 shedding, and the internal elastic membrane was thin. To the extent that the muscular layer is intact, the discussion of hydraulic expansion for 319372 not only overcomes the spasm of the graft vein, but also facilitates the finding and ligation of small branches. Some scholars believe that after the vein has been hydraulically expanded, the diameter of the vein has been expanded to its original outer diameter, which is convenient for the application of anastomosed segmental hydraulic expansion in the arteries. 6,1.80, etc. 4 in adrenaline The method of relieving the arterial spasm in the study found that lidocaine hydrochloride chlorpromazine papaverine can relieve the arterial spasm, but the hydraulic expansion method has the strongest effect and the longest duration.
There are many causes of arterial spasm, mainly in several aspects. 1 Neurological spasm, caused by sympathetic excitation, often caused by factors such as cold pain. 2 Muscle spasm is caused by the high contraction of the smooth muscle fibers in the middle of the vessel wall. It is often caused by mechanical stimulation of the wound of the adventitia in the operation and mechanical stimulation of the blood vessel wall or postoperative fixation. Caused by stimulation. Anti-angiogenesis mainly takes the following measures 1 systemic aspects. Supplement blood volume, pain relief, heat preservation, etc. 2 drugs. Magnesium sulphate has obvious vasodilating effect in 25 or more environments, and its anticoagulant effect is achieved by inhibiting platelet activity and antagonizing calcium ions. 5; Lidocaine can cause platelet anticoagulation to inhibit plasma decidual content, resulting in The arterioles dilate and the changes are benign. 3 hydraulic expansion. Hydraulic expansion is used to prevent venous fistulas during vein grafting. Qian Jixian et al. reported that excessive pressure of venous hydraulic expansion can cause obvious damage to the vein wall, especially the endothelial cells, delaying the reconstruction of the internal moon Wu; 90, the above hydraulic expansion can lead to the reduction of the intimal elasticity. After the arterial hydraulic expansion, the transmission electron microscope and the scanning electron microscope 9 can be found that the hydraulic expansion pressure is 30,1, the damage caused by the vascular endothelial cells is minimal, and the complete repair can be obtained within 1 week; The hydraulic expansion pressure is 900, and at 8 o'clock, it can lead to the loss of 50 vascular endothelial cells and the rupture of the inner elastic membrane and smooth muscle and the extensive proliferation of the intimal and smooth muscle. Through histological studies, it can also be found that the pressure of hydraulic expansion is 300, 1 , the damage of elastic membrane and smooth muscle in vascular endothelial cells is lighter; and the damage of various layers of arteries is gradually worse than 60, 1 and 8. Fan Cunyi et al believe that the increase of the diameter of the arteries after hydraulic expansion is beneficial to increase the blood flow in the vascular anastomosis, and the increase of blood flow can enhance the scouring force of microemboli and reduce the incidence of vascular crisis.
It can be seen from the changes of skin temperature after tissue transplantation that the skin temperature of the transplanted tissue within 120 days after tissue transplantation is higher than that of the healthy tissue, which may be directly supplied by the iliac artery and the toe of the plantar artery after the artery is free. Relatedly, it may also be related to the increase of anastomosis and tissue blood flow after arterial hydraulic expansion. In this study, it was found that the endothelial cells of the dorsal artery of the foot had 15 shedding, while the unexpanded dorsal artery of the dorsal artery had 7 shedding, which was estimated to be related to mechanical damage during sectioning. Therefore, it is in the bounds.矣30, the hydraulic expansion is safe and effective. After hydraulic expansion, the elastic membrane in the artery is relaxed, and the distribution of the muscle layer is different due to the distribution of fibrous connective tissue. However, the thickness of the artery is not thick after expansion. At the same time, the diameter of the artery is enlarged after expansion, which is beneficial to increase the blood flow in the anastomotic region and reduce the adhesion of platelets. Attachment and accumulation reduce the occurrence of thrombosis, which is of great significance to improve the survival rate of transplanted tissues. It can also be seen from this research that in the free process of the pedicle of the arteries, some small branches may have a phenomenon of leakage, which is easy to cause continuous blood leakage after the blood circulation is established, which in turn causes the whole artery to be paralyzed, eventually leading to The occurrence of thrombosis and necrosis of the transplanted tissue. Therefore, we can find the unligated branches of the free arteries by hydraulic expansion and timely ligature. Because the diameter of the dorsal artery and the radial artery are different, especially when the diameter of the dorsal artery is smaller than that of the radial artery, the diameter of the dorsal artery can be increased by hydraulic expansion to facilitate vascular anastomosis.
In summary, the segmental hydraulic expansion method can overcome the paralysis of the arterial pedicle in the anatomical separation during tissue transplantation, and thus is an effective method for preventing and overcoming arterial spasm. However, due to excessive pressure on the structure and function of the blood vessel wall, the pressure during expansion should not exceed 30 1 Cai Peiqin, Zheng Yiliu, Dai Xiangyu. The academic significance of the symposium on the thumb interception classification. Chinese Journal of Orthopaedics, 2000, 20319320.2 Gu Yudong. The classification of the thumb interception. Chinese Journal of Orthopaedics, 1999, 19380 5 Gu Yudong. Experimental study on vasodilator anticoagulant effect of magnesium sulfate. Chinese Journal of Surgery, 6 Jin Huiming, Gu Yudong, Zhang Guoping, et al. Lidocaine can be used to expand the arterioles of the hamsters. Chinese Journal of Orthopaedics, 1997, 44849.8 Fan Cunyi, Zeng Bingfang, Yan Shuping, et al. Ultrastructural study of hydraulic expansion on arterial action. Chinese Journal of Microsurgery, 2000, 23292293.9 Fan Cunyi, Zeng Bingfang, Yan Shuping, et al. Scanning electron microscopic observation of the effect of hydraulic expansion on arteries. Chinese Hand Surgery Magazine. 2000, 16241243.10 Fan Cunyi, Zeng Bingfang, Guo Ruihua, et al. The histological changes of the effect of hydraulic expansion on arteries. Edited by Yan Fuhong, the first edition of the message on bone and joint damage was edited by Wang Yizhen, and the first edition of the bone and joint injuries compiled by 24 domestic experts was published by People's Health in May 2001. The publication of the agency, the book is priced at 132 yuan. Another spinal internal fixation Lu Houshan translation price of 180 yuan; practical hip surgery Chen Weigao price of 75 yuan; osteotomy design and application research Zhang Guangbo pricing of 43 yuan; trauma orthopedics diagnosis and treatment mistakes Hu Guang pricing 5, the United States the latest clinical medical questions and answers The orthopedics price of 37 yuan sports system anatomy price of 76 yuan.
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