Isogai N, Fukunishi K, Kamiishi H
Department of Plastic Surgery, Kinki University School of Medicine, Osaka, Japan.
Microsurgery. 1992;13(6):321-4. doi: 10.1002/micr.1920130606.
The purpose of this study is to describe our technique of applying fibrin glue at the microvascular anastomotic site and to evaluate the effect of fibrin glue on anastomotic hemostasis and patency under various high pressure states using dopamine-induced acute hypertension in rats. A total of 72 male Wistar Kyoto rats, 10 weeks old, were used in this study. Under urethane anesthesia, end-to-end anastomosis of the left femoral artery was performed using 10-0 nylon suture by the standard interrupted suture technique. Pasteurized fibrin glue was then topically applied upon the suture line of the anastomosis. Thirty-six normotensive rats were divided into three groups based on the number of sutures (4, 6, or 8) used to complete the anastomosis. Groups were subdivided, half receiving fibrin glue application and half without. Thirty-six dopamine-induced acutely hypertensive rats were divided into three groups based on the blood pressure levels of 150, 200, and 250 mmHg, respectively. These groups were again subdivided, with half receiving glue applications. Microvascular anastomosis was performed using 6 nylon sutures. Patency rates and anastomotic bleeding were evaluated. The results revealed that successful anastomoses could be performed with fewer sutures when fibrin glue was used as a reinforcement at the anastomosis. Fibrin glue was also effective at the maximum blood pressure (250 mmHg) with no anastomotic leakage and no decrease in postoperative patency rate. These results suggest that conventional microsurgical suturing technique combined with fibrin glue would be effective in the prevention of leakage in microsurgical repairs, even under conditions of high blood pressure.
本研究的目的是描述我们在微血管吻合部位应用纤维蛋白胶的技术，并使用多巴胺诱导大鼠急性高血压，评估纤维蛋白胶在各种高压状态下对吻合口止血和通畅性的影响。本研究共使用了72只10周龄的雄性Wistar Kyoto大鼠。在乌拉坦麻醉下，采用标准间断缝合技术，用10-0尼龙缝线进行左股动脉端端吻合。然后将经巴氏消毒的纤维蛋白胶局部应用于吻合口缝线处。36只血压正常的大鼠根据完成吻合所用缝线数量（4、6或8）分为三组。每组再细分，一半接受纤维蛋白胶应用，另一半不接受。36只多巴胺诱导的急性高血压大鼠分别根据血压水平150、200和250 mmHg分为三组。这些组再次细分，一半接受胶水应用。使用6根尼龙缝线进行微血管吻合。评估通畅率和吻合口出血情况。结果显示，当在吻合处使用纤维蛋白胶作为加强材料时，用较少的缝线就能成功进行吻合。纤维蛋白胶在最高血压（250 mmHg）时也有效，没有吻合口漏血，术后通畅率也没有降低。这些结果表明，传统的显微外科缝合技术与纤维蛋白胶相结合，即使在高血压情况下，也能有效预防显微外科修复中的漏血。
