Objective To investigate the enhancement of the transverse rectusabdominis musculocutaneous (TRAM) flap survival in local ischemic area by recombinant adenovirus mediated vascular endothelial growth factor 165 gene(Ad-VEGF-165). Methods The vascular pedicle TRAM flaps were made in the right abdomin of30 SD rats and they were randomly divided into 5 groups. The Ad-VEGF-165 was injected into the subcutaneous tissue of epigastra(group 1), the subcutaneous tissue of epigastria and rectus abdominis muscle (group 2), and the rectus abdominis muscle(group 3); Adenovirus mediated green fluorescent protein(Ad-GFP) and DMEMwere injected into the subcutaneous tissue of epigastria and rectus abdominis muscle as autocontrol(group 4) and blank control(group 5), respectively. The survival areas of TRAM flap was measured after 7 days of operation. The microvascular density(MVD) and the integral optical density (IOD) were tested with anti-rat CD34 and with VEGF immunohistochemistry and insitu hybridization histochemistry (ISHH), respectively. Results The survivalareas of TRAM flap in groups 1, 2 and 3 (14.19±2.77, 15.18±2.18 and 8.30±1.28 cm2) were higher than those in groups 4 and 5(4.12±186 and 3.60±1.95 cm2), being significant differences(Plt;0.05).The CD34 MVD of the TRAMflap in groups 1, 2 and 3 was higher than that in groups 4 and 5; the positiveexpression for VEGF and ISHH were shown in groups 1, 2 and 3 and there was significant difference when compared with groups 4 and 5 (Plt;0.05). Conclusion Treatment by recombinant Ad-VEGF165gene is an effective option for enhancement of the TRAM flap survival in the local ischemic area.
目的 探討應用負壓輔助愈合治療系統（V.A.C. Therapy）在胸、腹、背部斷層皮片游離移植術后加壓固定的有效性。 方法 2010年10月－2011年10月，應用V.A.C. Therapy加壓固定游離斷層皮片修復21例胸、腹、背部皮膚軟組織缺損患者。男15例，女6例；年齡21～63歲，平均43歲。其中瘢痕切除后創面13例，皮瓣切取后供瓣區形成的創面8例。創面位于胸部7例，腹部9例，背部5例。皮膚及軟組織缺損范圍12 cm×10 cm～18 cm×15 cm。游離移植的斷層皮片厚度為0.6 mm，在缺損部位移植斷層皮片后，使用V.A.C. Therapy固定皮片，壓力范圍100～125 mm Hg （1 mm Hg=0.133 kPa）。 結果 住院時間19～32 d，平均24 d。21例植皮均成活，受區創面Ⅰ期愈合；供皮區創面Ⅰ期愈合。隨訪時間6～12個月，平均8個月。游離移植皮膚色澤與周圍皮膚色澤相似，無破潰，無明顯凹陷。 結論 應用V.A.C. Therapy加壓固定的游離斷層皮片，成活率高，效果可靠，是一種安全實用的固定方法。