백서복부의 혈관경 다양화에 따른 도서형 피판들의 생존률에 관한 비교 연구

Abstract

[한글]

창상을 방치하면 체액손실, 전해질의 불균형, 에너지의 소모, 기능손실과 동통 및 추형을 가져오게 된다. 따라서 일단 발생한 창상은 적당한 시기에 적절한 피복방법을 선택하여 재건하는 것이 원칙이다. 간단한 창상은 일차봉합술로 복원시킬 수 있으나, 복합창상

은 피부이식 또는 피판슬을 시행하게 된다. 피판슬은 피부이식보다 기능적 미용적으로 우수하지만, 신체내에서 이용 가능한 피판은 한정되어 있으므로 많은 사체실험과 동물실험을 통하여 연구되어 왔다. 그러나, 새로운 피판이 개발되거나 피판에 관한 실험을 하고자

할 때는 동물실험이 선행되어야 할 것이다.

최근에 피판의 동맥이나 정맥만에 의한 구조나 정맥피판 등 많은 변형된 피판이 응용되고 있으나 실제로 피판 서로간의 생존율에 대한 비교는 흔치 않다. 본 실험은 백서 복부의 양쪽에 2 × 5Cm 크기의 피판을 작성하고 다음과 같은 3가지 형태의 혈관경을 가진 도서형 피판을 만들어 각 실험군들의 생존율을 비교하고 분석함으로써 이상적 동맥피판은 어떤 형태인지 그리고 정맥피판의 사용 타당성에 대한 실험적 근거를 마련하고자 하였다.

제 1군은 하부천복벽정맥(superficial inferior epigastric vein)을 통하여 혈액이 공급되고 외측 흉복벽정맥(lateral thoracoepigastric vein)을 통하여 혈액이 유출되며, 제 2군은 하부천복벽동맥(superficial inferior epigastric artery)을 통하여 혈액공급이 되고 외측 흉복벽정맥(lateral thoracoepigastric vein)으로 혈액유출이 이루어지고, 제 3군은 하부천복벽동맥(superficial inferior epigastric artery)으로 혈액공급이 되고 하부천복벽정맥(Superficial inferior epigastric vein)으로 혈액유출이 되도록 하였다. 또 복합조직이식 형태를 제 4군으로 하여 대조군으로 하였다. 수술 후 3주에 피판 생존율을

평가한 결과, 제 1군은 80.72%, 제 2군은 92.39% 였으며, 제 3군은 80.32% 였으나, 제 4군은 0.94% 가 각각 생존하였다. 즉 동맥피판으로써 혈액공급을 하는 동맥과 혈액유출이 되는 정맥이 피판에서 서로 멀리 떨어짐으로써 피판 전체에 고르게 혈액순환이 이루어지는 제 2군의 생존율이 가장 우수하였으며, 정맥에 의하여 정맥혈이 공급되고 정맥에 의하여 혈액유출이 이루어지는 정맥피판인 제 1군과 동맥피판이지만 혈액공급과 혈액유출이 매우 가까운 곳에서 이루어지는 제 3군과는 통계학적인 차이 없이 비슷한 결과를 보였다.

이상의 실험결과로써 백서 복부에서 도서형 피판을 선택 사용할 때, 현재까지 자주 사용되어왔던 '하부천복벽동맥을 혈액공급원으로 하고, 하부천복벽정맥을 혈액유출원'으로 하는 기존의 백서 복부에서의 도서형 피판 대신에 '혈액공급원을 하부천복벽동맥으로 하고,

혈액유출원을 외측 흉복벽정맥'으로 하는 도서형 피판의 사용이 바람직하며, 백서북부에서 정맥피판의 실험형태로써 '하부천복벽정맥을 혈액공급원으로 하고, 외측 흉복벽정맥을 혈액유출원으로'하는 도서형 피판도 사용이 가능하다. 또한 피판을 선택할 때 '동맥을 혈액공급원으로 하고 정맥을 혈액유출원'으로 사용하기가 힘들 경우에는 '정맥에 의하여 혈액이 공급되고 정맥으로 혈액이 유출'되는 소위 정맥피판도 임상적으로 사용 가능할 것으로 사료된다.

Island models of rat abdomen and the comparative analysis of their survival rates

Hoon Bum Lee

Department of Medicine Science, The Graduate School, Yonsei University

(Directed by Associate Professor Chul Park)

The raw surface of the wound results in the imbalance of electrolytes, pain and

loss of function and ultimately ugly scar. Therefore, the wound is, in principle,

closed with the proper operative methods at the optical timing. Simple wound is

restored by primary wound closure but complex wound requisites skin graft or flap.

The flap surgery, which is limited in human, is better than the skin graft in

function or aesthetics. So many anatomists and plastic surgeons have been studying

and developing in this field with cadavar or animal. When new flap is developed or

further studies of th? flap are needed, the experimental study should be preceded

with animal.

The purpose of this study is to investigate the survival rates of flaps supplied

with various vascular pedicles. Flaps, 2 × 5 cm sized, were elevated from the

abdomen of white rats(Sprague Dawley, 250-300gm). The twenty rats were divided into

4 groups, In each group consisted of five rats, a different vascular pedicle was

included in the abdominal flaps. In group 1the blood supply of the flap was made by

the superficial inferior epigastric vein(SIEV) and drained out through the lateral

thoracoepigastric vein : in group 2, the superficial inferior epigastric

artery(SIEA) was supplied the blood inflow and drained out through the lateral

thoracoepigastric vein : in group 3, the blood inflow was made by the superficial

inferior epigastric artery (SIEA) and the blood outflow was made through the

superficial inferior epigastric vein(SIEV) : in group 4, the control group, no

pedicle was included. The room temperature was 25 degrees Celcius. On each side of

abdomen, 2 × 5 cm-sized flap was elevated including panniculus carvenosus. A thin

silastic sheath was applied under the base of flap, and the flap was fixed. After

the operation, the extremities and neck were splinted to prevent self-mutilation.

After three weeks, the size of the survived flap was measured, and the percentage

of survived flap was obtained by comparing the original size. A rat of the group 3

died during the experiment. So, further one experimental study of the group 3 was

performed. A total of 40 data was obtained from the 20 survived rats. The data were

analyzed statistically. The survival rate of group 1 was 80.72% : group 2, 92.39% :

group 3, 80.32% and group 4 was 0.94%. Namely, the group 2,as the model of the

arterial inflow and venous outflow but enough circulation and perfusion

accomplished, survived the best. Fair survival rate of group 1 strongly supports

the feasibility of the new theory, the survival of flap can be ensured if

sufficient flap perfusion is provided to maintain cellular integrity, independent

of the route of vascular supply. Comparing the group 3, although not statistical

significance, the group 1 survived similar. This implies that the flap perfusion is

the single 7o7t important factor in the flap survival. Based on the above

experiments, 1 conclude the followings : at the selection of the rat abdominal

island flap model, the superficial inferior epigastric artery to lateral

thoracoepigastric vein is more ideal than the superficial inferior epigastric

artery to superficial inferior epifastric vein which was as a conventional model.

The bipedicled venous island flap, the venous blood inflow and venous blood

outflow, is useful clinically.

[영문]

The raw surface of the wound results in the imbalance of electrolytes, pain and loss of function and ultimately ugly scar. Therefore, the wound is, in principle, closed with the proper operative methods at the optical timing. Simple wound is restored by primary wound closure but complex wound requisites skin graft or flap.

The flap surgery, which is limited in human, is better than the skin graft in function or aesthetics. So many anatomists and plastic surgeons have been studying and developing in this field with cadavar or animal. When new flap is developed or further studies of th? flap are needed, the experimental study should be preceded with animal.

The purpose of this study is to investigate the survival rates of flaps supplied with various vascular pedicles. Flaps, 2 × 5 cm sized, were elevated from the abdomen of white rats(Sprague Dawley, 250-300gm). The twenty rats were divided into 4 groups, In each group consisted of five rats, a different vascular pedicle was included in the abdominal flaps. In group 1the blood supply of the flap was made by the superficial inferior epigastric vein(SIEV) and drained out through the lateral

thoracoepigastric vein : in group 2, the superficial inferior epigastric artery(SIEA) was supplied the blood inflow and drained out through the lateral thoracoepigastric vein : in group 3, the blood inflow was made by the superficial inferior epigastric artery (SIEA) and the blood outflow was made through thesuperficial inferior epigastric vein(SIEV) : in group 4, the control group, no pedicle was included. The room temperature was 25 degrees Celcius. On each side of abdomen, 2 × 5 cm-sized flap was elevated including panniculus carvenosus. A thin silastic sheath was applied under the base of flap, and the flap was fixed. After the operation, the extremities and neck were splinted to prevent self-mutilation.

After three weeks, the size of the survived flap was measured, and the percentage of survived flap was obtained by comparing the original size. A rat of the group 3 died during the experiment. So, further one experimental study of the group 3 was performed. A total of 40 data was obtained from the 20 survived rats. The data were analyzed statistically. The survival rate of group 1 was 80.72% : group 2, 92.39% : group 3, 80.32% and group 4 was 0.94%. Namely, the group 2,as the model of the arterial inflow and venous outflow but enough circulation and perfusion accomplished, survived the best. Fair survival rate of group 1 strongly supports the feasibility of the new theory, the survival of flap can be ensured if sufficient flap perfusion is provided to maintain cellular integrity, independent of the route of vascular supply. Comparing the group 3, although not statistical

significance, the group 1 survived similar. This implies that the flap perfusion is the single 7o7t important factor in the flap survival. Based on the above experiments, 1 conclude the followings : at the selection of the rat abdominal island flap model, the superficial inferior epigastric artery to lateral

thoracoepigastric vein is more ideal than the superficial inferior epigastric artery to superficial inferior epifastric vein which was as a conventional model.

The bipedicled venous island flap, the venous blood inflow and venous blood outflow, is useful clinically.