Salerno G M, McBride D M, Bleicher J N, Watson P, Stromberg B V
Creighton University School of Medicine, Division of Plastic and Reconstructive Surgery, Omaha, NE 68131.
Ann Plast Surg. 1992 Jun;28(6):526-33; discussion 534.
Survival of random skin flap distal end depends on hemodynamic, cellular, and coagulation mechanisms. This study was designed to evaluate whether administration of ciprostene, a stable prostaglandin I2 analogue, and indomethacin, a cyclooxygenase-hydroperoxydase enzyme inhibitor, would improve the survival rate of random skin flaps. Forty-five male rats were divided into nine groups and injected with sesame oil (control), ciprostene (20 micrograms/kg/day), and/or indomethacin (2 mg/kg/day). Injections were done before (pretreatment for 4 days), after (posttreatment for 6 days), and before/after (pre/posttreatment for 4 and 6 days, respectively) the elevation of random dorsal skin flaps. In the pretreatment and pre/posttreatment studies, the flap survival rate of all drug-injected groups was significantly higher than that of the control group (p less than 0.02). In addition administration of ciprostene alone yielded a trend of better flap survival rate, which, however, was not statistically significant (p less than 0.12). Of interest in the posttreatment study, only the simultaneous administration of ciprostene and indomethacin significantly increased skin flap viability compared with the other groups (p less than 0.02). Therefore, the results demonstrated that administration of ciprostene and indomethacin either alone or together partially reversed the pathophysiological mechanisms that cause necrosis of random skin flap distal end. These pharmacological changes significantly improved random skin flap survival rate.
随意皮瓣远端的存活取决于血流动力学、细胞和凝血机制。本研究旨在评估给予稳定的前列腺素I2类似物西前列烯和环氧化酶-氢过氧化物酶抑制剂吲哚美辛是否能提高随意皮瓣的存活率。45只雄性大鼠被分为9组，分别注射芝麻油（对照组）、西前列烯（20微克/千克/天）和/或吲哚美辛（2毫克/千克/天）。在掀起背部随意皮瓣之前（预处理4天）、之后（后处理6天）以及之前/之后（分别预处理4天和后处理6天）进行注射。在预处理和预处理/后处理研究中，所有注射药物组的皮瓣存活率均显著高于对照组（p<0.02）。此外，单独给予西前列烯有皮瓣存活率更高的趋势，但无统计学意义（p<0.12）。在后处理研究中，有趣的是，与其他组相比，仅同时给予西前列烯和吲哚美辛能显著提高皮瓣活力（p<0.02）。因此，结果表明单独或联合给予西前列烯和吲哚美辛可部分逆转导致随意皮瓣远端坏死的病理生理机制。这些药理学变化显著提高了随意皮瓣的存活率。
