Wolfort S F, Angel M F, Knight K R, Amiss L R, Morgan R F
Department of Plastic Surgery, University of Virginia Health Sciences Center, Charlottesville.
J Reconstr Microsurg. 1992 Sep;8(5):375-8. doi: 10.1055/s-2007-1006721.
Dextran lowers the probability of thrombus formation, by reducing platelet aggregation and adhesion and by increasing fibrinolysis. All studies to date using dextran for microvascular reconstruction have examined only short-term (1 to 2 hr) patency in isolated vessels. The current study used an established thrombotic model (inverted sleeve interposition graft), to investigate the effect of dextran on the long-term survival of pedicle flaps. A6- x 3-cm epigastric flap was elevated. A 2-mm inverted sleeve interposition graft was placed on the artery side of the pedicle by microvascular techniques. One group received dextran (17 cc/kg) 2 hr preoperatively and every 6 hr postoperatively for the next 72 hr. A control group received saline on the same schedule. Survival was assessed on postoperative day 7, at which time necrosis was obvious. Several parameters (clotting studies and electron microscopy) were studied to characterize the phenomenon more clearly. Only 25 percent of saline-treated flaps survived (2/8), while all dextran-treated flaps survived (7/7) (p less than 0.02, Fisher exact test). Thus, dextran allowed flaps to survive by preventing thrombus formation, despite a strong thrombogenic focus.
右旋糖酐通过降低血小板聚集和黏附以及增强纤维蛋白溶解作用，降低血栓形成的可能性。迄今为止，所有使用右旋糖酐进行微血管重建的研究仅考察了其在离体血管中的短期（1至2小时）通畅情况。本研究采用一种成熟的血栓形成模型（倒置袖套植入移植物），来研究右旋糖酐对带蒂皮瓣长期存活的影响。掀起一块6×3厘米的上腹部皮瓣。通过微血管技术在蒂部的动脉侧放置一个2毫米的倒置袖套植入移植物。一组在术前2小时接受右旋糖酐（17毫升/千克），术后每6小时给药一次，持续72小时。对照组按相同给药方案给予生理盐水。在术后第7天评估皮瓣存活情况，此时坏死情况明显。研究了几个参数（凝血研究和电子显微镜检查）以更清楚地描述该现象。接受生理盐水治疗的皮瓣仅25%存活（2/8），而所有接受右旋糖酐治疗的皮瓣均存活（7/7）（P＜0.02，Fisher精确检验）。因此，尽管存在强烈的血栓形成病灶，但右旋糖酐通过防止血栓形成使皮瓣得以存活。
