Pellitteri P K, Kennedy T L, Youn B A
Department of Otolaryngology and Head and Neck Surgery, Geisinger Medical Center, Danville, Pa 17822-1333.
Arch Otolaryngol Head Neck Surg. 1992 Oct;118(10):1050-4. doi: 10.1001/archotol.1992.01880100040011.
Conflicting reports exist regarding the influence of hyperbaric oxygen therapy on random skin flap survival. The present investigation sought to demonstrate enhanced survival of experimental random skin flaps in swine using an intensive and tapering hyperbaric oxygen therapy regimen that would have direct application in human clinical trials. Random cutaneous flaps were surgically constructed on 12 domestic pigs. Flaps were designed to obtain a predictable length of necrosis. Six pigs did not undergo hyperbaric oxygen therapy and served as surgical controls. Six pigs were subjected to an intensive tapering hyperbaric regimen within 1.5 hours of completing the surgical procedure. Treatments were administered in a research hyperbaric vessel at a depth of 2.0 atm absolute (10 m of seawater) for 90 minutes of oxygen treatment in a tapering schedule over 6 days. This was structured to provide intensive therapy initially during the period of maximum tissue trauma and ischemia. Extent of flap necrosis was assessed by tracing clear plastic templates at necropsy, then converting to square centimeters using a computer digitizer tablet. The difference in flap necrosis between groups was significant, with random flaps subjected to hyperbaric oxygen therapy demonstrating a mean 35% less necrosis than surgical controls. Skin flaps treated with hyperbaric oxygen therapy demonstrated a mean survival of 77%, with a range of 56% to 100%. This reflected a 12% improvement in mean surviving area for hyperbaric oxygen therapy flaps over untreated surgical controls. We are unaware of similar studies reporting a comparable degree of enhancement in random skin flap survival using hyperbaric oxygen therapy alone. Adjunctive hyperbaric oxygen therapy in an intensive tapering schedule significantly improved flap survival in this model. Further investigations need to determine the optimum frequency of treatments and depth necessary to attain maximum tissue viability.
关于高压氧疗法对随意皮瓣存活的影响，存在相互矛盾的报道。本研究旨在通过一种强化和逐渐减量的高压氧治疗方案，证明在猪身上实验性随意皮瓣的存活得到增强，该方案将直接应用于人类临床试验。在12头家猪身上手术构建随意皮瓣。设计皮瓣以获得可预测的坏死长度。6头猪未接受高压氧治疗，作为手术对照组。6头猪在完成手术程序后的1.5小时内接受强化逐渐减量的高压氧治疗方案。治疗在一个研究用高压舱内进行，绝对深度为2.0个大气压（10米海水），按照逐渐减量的时间表在6天内进行90分钟的氧气治疗。这样设计是为了在最大组织创伤和缺血期间最初提供强化治疗。在尸检时通过追踪透明塑料模板评估皮瓣坏死程度，然后使用计算机数字化仪平板转换为平方厘米。两组之间皮瓣坏死的差异显著，接受高压氧治疗的随意皮瓣坏死平均比手术对照组少35%。接受高压氧治疗的皮瓣平均存活率为77%，范围为56%至100%。这反映出接受高压氧治疗的皮瓣平均存活面积比未治疗的手术对照组提高了12%。我们不知道有类似的研究报告仅使用高压氧疗法能使随意皮瓣存活得到如此程度的增强。在本模型中，采用强化逐渐减量时间表的辅助高压氧疗法显著提高了皮瓣存活率。进一步的研究需要确定达到最大组织活力所需的最佳治疗频率和深度。
