Influence of venous stasis on survival of epigastric flaps in rats
Influence of venous stasis on survival of epigastric flaps in rats
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DOI：
10.1016/j.bjoms.2018.01.019
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发表时间：
2018-05-01
影响因子：
1.8
通讯作者：
Ritschl, L. M.
中科院分区：
文献类型：
--
作者：
Muecke, T.;Schmidt, L. H.;Ritschl, L. M.
静脉淤血会导致组织损伤，如果没有及早发现，静脉淤血仍然是微血管游离皮瓣移植失败的最常见原因。本研究的目的是测量静脉淤血的临界持续时间，并根据静脉淤血的持续时间来确定皮瓣的存活率。在35只大鼠中提起标准上腹部皮瓣并重新定位，其中7只作为对照。其余时间完全阻断腹壁下浅静脉4、5、6或7小时（每组n = 7）。随后，监测大鼠一周，并对所产生的坏死区域拍照。静脉停滞5、6和7小时后，坏死的发生率和面积显著增加（均为p = 0.04），高于对照组。静脉停滞7小时后的坏死程度显著大于4或5小时后的坏死程度（分别为p = 0.01和0.02）。静脉充血的持续时间是游离皮瓣存活的潜在风险，因为它会导致手术并发症，并可能危及整个手术。在静脉停滞的关键时期后，我们到达了一个不可逆转的点，任何挽救受损皮瓣的尝试都将是徒劳的。基于这些结果，我们认为由一位经验丰富的外科医生在不超过三小时的时间间隔内进行监测是成功挽救微血管游离皮瓣静脉淤血的必要条件。(C)2018年英国口腔颌面外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Venous congestion results in tissue damage and remains the most common reason for failure of transfer of microvascular free flaps if it is not recognised early. The purpose of this study was to measure the critical duration of venous congestion and the resultant survival of flaps according to the duration of venous stasis. A standard epigastric flap was raised and repositioned in 35 rats, seven of which acted as controls. The superficial inferior epigastric vein was fully occluded for four, five, six, or seven hours in the rest (n = 7 each group). Subsequently, the rats were monitored for one week, and the resultant necrotic areas were photographed. After five, six, and seven hours of venous stasis, the incidence and area of necrosis were significantly increased (p = 0.04 in each) above that of the control. The degree of necrosis after seven hours of venous stasis was significantly greater than that after four or five hours (p = 0.01 and 0.02, respectively). The duration of venous congestion is therefore a potential risk for the survival of free flaps, as it results in operative complications and may jeopardise the whole procedure. After a critical period of venous stasis we reach a point of no return, and any attempt to salvage the compromised flap will be in vain. Based on these results, we think that monitoring by an experienced surgeon at intervals of no longer than three hours is essential for the successful salvage of venous congestion in microvascular free flaps. (C) 2018 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.