Impact of hypertonic-hyperoncotic saline solutions on ischemia-reperfusion injury

高渗高胶盐溶液对缺血再灌注损伤的影响

• 批准号: 7642359
• 负责人: ANTHONY J DURKIN
• 金额: $ 7.64万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7642359
• 关键词: Arteries; Blood Vessels; Blood capillaries; Blood flow; Caring; Clinical; Data; Dermal; Development; Diabetic Angiopathies; Diffuse; Dorsal; Evaluation; Excision; Failure; Healed; Health; Hemoglobin; Hemorrhage; Hydration status; Image; Imaging Device; Inguinal region; Injury; Investigation; Ischemia; Lead; Length of Stay; Lighting; Liquid substance; Location; Malignant Neoplasms; Maps; Measures; Mechanics; Medical; Methods; Microsurgery; Modeling; Monitor; Morbidity - disease rate; Necrosis; Operative Surgical Procedures; Optics; Outcome; Oxygen; Patients; Pattern; Perfusion; Phase; Postoperative Period; Process; Property; Rattus; Reconstructive Surgical Procedures; Recovery; Reperfusion Injury; Reperfusion Therapy; Research; Risk; Rodent; Saline; Site; Skin; Spectrum Analysis; Surgeon; Surgical Flaps; Technology; Testing; Tissues; Trauma; Uncertainty; Variant; Veins; Venous; Water; artery occlusion; base; capillary; chromophore; cost; experience; healing; improved; in vivo; new technology; public health relevance; response; skin color; standard of care; tissue oxygenation; tissue reconstruction

DESCRIPTION (provided by applicant): The central aim of the proposed research is to assess the viability of Modulated Imaging as a method that will provide objective functional parameters that can be used to determine status of tissue reconstruction flaps under conditions of venous and arterial occlusion and in response to reperfusion using hypertonic -hyperoncotic saline solutions. The use of tissue transfer flaps is a method of moving tissue from a donor location to recipient location and re-attaching the arteries & veins to the blood vessels at the recipient site. The medical utility of this process is to allow for reconstructive surgery after trauma, as well as after surgical resection of cancer. This type of surgery is subject to failure however, which may be due to1) vascular insufficiency caused by to mechanical obstruction of the artery or vein; 2) injury caused to the transferred tissues due to the lack of blood flow when a free tissue flap is performed; or 3) due to ischemia-reperfusion (I/R) injury, which results after blood flow has been returned to the transferred tissue. The first postoperative days after free tissue transfer are characterized by the risk of microvascular complications and loss of transferred tissue by necrosis. Loss of a tissue transfer flap is a devastating experience to both the surgeon and the patient. Strategies for reducing flap loss involve both development of new technologies that detect flap compromise and the use of fluids that minimize ischemia-reperfusion injury. Early in the era of microsurgery, flap monitoring was performed based on clinical observation of skin color, capillary refill, and dermal bleeding. In fact, this remains the standard of care. However, issues related to staffing and subjective variations related to making a clinical determination of a flap's perfusion have led to the search for objective methods of assessment of flap status. One promising technology for measuring tissue oxygenation in-vivo is Modulated Imaging (MI). MI is a noncontact imaging approach based on diffuse optical spectroscopy principles that employs patterned illumination. MI enables rapid quantitative determination of the optical properties over a wide field-of-view. When combined with multi-spectral imaging, MI can quantify in-vivo concentrations of chromophores that are relevant to flap health, namely, oxy- and deoxy-hemoglobin and water concentration. We present results of a preliminary in-vivo MI study using a rodent dorsal skin pedicle flap model. This allowed us to evaluate the feasibility of MI to deduce spatially resolved maps of tissue hemoglobin, oxygenation and hydration. Here we propose that MI can be used for quantitative assessment of flaps in response to vascular occlusion and reperfusion with the aid of hypertonic-hyperoncotic saline solutions. The results of the proposed research will inform further investigations involving MI within the domain of tissue transfer flaps, with the ultimate objective of developing and deploying this technology in the clinical domain. PUBLIC HEALTH RELEVANCE: The use of tissue transfer flaps is a method of moving tissue from a donor location to recipient location and re-attaching the arteries & veins to the blood vessels at the recipient site. This type of reconstructive surgery is subject to failure however, which may include complications due to ischemia-reperfusion injury and vascular insufficiency. We propose to test a new imaging device that will have the capability to guide reconstructive surgery and post-surgical recovery, both reducing post-surgery morbidity and reducing uncertainty in flap healing. Ultimately, if shown to be effective, this technology may lead to reduced duration of hospital stay and concomitant heath care costs in addition to improving surgical outcomes.

描述（由申请人提供）：拟定研究的主要目的是评估调制成像作为一种方法的可行性，该方法将提供客观功能参数，可用于确定静脉和动脉闭塞条件下组织重建皮瓣的状态以及对使用高渗-高渗盐水溶液进行再灌注的反应。组织转移皮瓣的使用是一种将组织从供体位置移动到受体位置并将动脉和静脉重新连接到受体部位的血管的方法。该过程的医疗效用是允许创伤后以及癌症手术切除后的重建手术。然而，这种类型的手术容易失败，这可能是由于1）动脉或静脉的机械性阻塞引起的血管功能不全; 2）当进行游离组织瓣时由于缺乏血流而对转移的组织造成的损伤;或3）由于缺血-再灌注（I/R）损伤，其在血流已经返回到转移的组织之后产生。游离组织移植后的第一个术后天数的特征在于微血管并发症和坏死导致的移植组织损失的风险。组织转移皮瓣的丢失对外科医生和患者来说都是一种毁灭性的经历。减少皮瓣丢失的策略包括开发检测皮瓣损伤的新技术和使用最小化缺血再灌注损伤的液体。在显微外科时代的早期，皮瓣监测是根据皮肤颜色，毛细血管再充盈和皮肤出血的临床观察进行的。事实上，这仍然是护理标准。然而，与人员配备和主观变化有关的问题，使皮瓣的灌注临床测定导致的皮瓣状态评估的客观方法的搜索。用于测量体内组织氧合的一种有前途的技术是调制成像（MI）。MI是一种非接触式成像方法，其基于采用图案化照明的漫射光学光谱学原理。MI能够在宽视场范围内快速定量测定光学特性。当与多光谱成像相结合时，MI可以量化与皮瓣健康相关的发色团的体内浓度，即氧合血红蛋白和脱氧血红蛋白以及水浓度。我们提出了一个初步的体内心肌梗死研究的结果，使用啮齿动物背部皮肤蒂皮瓣模型。这使我们能够评估MI推断组织血红蛋白、氧合和水合的空间分辨图的可行性。在这里，我们建议，MI可以用于定量评估皮瓣血管闭塞和再灌注的援助，高渗高渗盐溶液。拟议研究的结果将为组织转移皮瓣领域内涉及MI的进一步调查提供信息，最终目标是在临床领域开发和部署这项技术。公共卫生关系：组织转移皮瓣的使用是一种将组织从供体位置移动到受体位置并将动脉和静脉重新连接到受体部位的血管的方法。然而，这种类型的重建手术容易失败，这可能包括由于缺血再灌注损伤和血管功能不全引起的并发症。我们建议测试一种新的成像设备，该设备将有能力指导重建手术和术后恢复，既减少术后发病率，又减少皮瓣愈合的不确定性。最终，如果证明是有效的，这项技术可能会导致减少住院时间和伴随的医疗保健费用，除了改善手术结果。