Yilmaz M, Menderes A
Department of Plastic and Reconstructive Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
Ann Plast Surg. 1999 Jul;43(1):67-73. doi: 10.1097/00000637-199907000-00010.
Replantation of amputated digits at distal levels is difficult because the vessels are either too small or absent in the amputated part. Clinically unconventional anastomoses have been tried in such instances. Arterialization of the venous system in the amputated part was also utilized for this purpose. In this study, a digital replantation model utilizing the amputated rabbit ear was used to evaluate the survival, metabolism, and perfusion of unconventionally replanted parts. Mean survival areas were measured and perfusion studies with technetium 99m, blood gases, pH, blood glucose and lactate levels, tissue glucose and lactate levels, and histological evaluations were performed. Surviving areas did not reveal a significant difference. Perfusion of the arterialized venous replants were not as good as the conventionally replanted ears. The blood glucose and lactate levels in the afferent vein were initially near normal arterial levels but almost reached normal venous levels in the samples taken 24 hours after the arterialized venous replantation. Tissue glucose levels were lower than the conventionally perfused tissue, and the lactate levels were higher, but these two metabolite levels were normalized in later samples. The results of the metabolic and perfusion studies are interpreted to elucidate the survival mechanisms in the arterialized venous replants. As a result, arterialized venous replantation may be supported by the favorable results of metabolic and perfusion studies in our experimental model.
远端断指再植难度较大，因为断离部分的血管要么过细，要么缺失。临床上在这种情况下尝试过非常规吻合术。断离部分的静脉系统动脉化也用于此目的。在本研究中，利用断离的兔耳建立了断指再植模型，以评估非常规再植部分的存活、代谢及灌注情况。测量了平均存活面积，并进行了锝99m灌注研究、血气分析、pH值、血糖和乳酸水平、组织葡萄糖和乳酸水平以及组织学评估。存活面积未显示出显著差异。动脉化静脉再植的灌注情况不如常规再植的耳朵。动脉化静脉再植后，传入静脉中的血糖和乳酸水平最初接近正常动脉水平，但在术后24小时采集的样本中几乎达到正常静脉水平。组织葡萄糖水平低于常规灌注组织，乳酸水平较高，但这两种代谢物水平在后续样本中恢复正常。代谢和灌注研究结果有助于阐明动脉化静脉再植的存活机制。因此，在我们的实验模型中，代谢和灌注研究的良好结果可能支持动脉化静脉再植。
