Turk J B, Zhang W X, Babajanian M, Urken M L, Biller H F, Weinberg H
Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Medical Center, New York, NY 10029-6574.
J Reconstr Microsurg. 1991 Oct;7(4):305-9; discussion 311-2. doi: 10.1055/s-2007-1006788.
The benefit of perfusion washout in both experimental and clinical skin flaps has long been debated. By perfusing ischemic rat pedicled flaps with UW solution, a recently developed, high-molecular-weight, organ-preservation medium, a 170 percent increase in the critical ischemia time of treated versus untreated control flaps was demonstrated. Sixty rats were used in this study. A 3- x 6-cm unilateral abdominal skin flap based on the superficial inferior epigastric artery and vein was raised. The flaps were divided into three groups: Group 1 (control--no perfusion washout (n = 15); Group 2 (LR)--perfusion washout with lactated Ringer's solution (n = 15); Group 3 (UW)--perfusion washout with UW solution (n = 30). Flaps were subjected to varying periods of ischemia, ranging between 8 and 30 hr. The primary ischemia time at which 50 percent of the flaps survived clinically was 10 hr for Group 1, 15 hr for Group 2, and 27 hr for Group 3. The differences between the survival rates for flaps in Groups 1, 2, and 3 were statistically significant (p less than .0005). By bathing the vascular and parenchymal cells in an impermeant preservation solution, it was hypothesized that cellular swelling would be inhibited, thereby significantly improving a skin flap's tolerance to warm ischemia. Furthermore, after reviewing the pertinent literature, it is evident that the primary critical ischemia time of 27 hr is the highest reported to date for the normothermic experimental rat pedicled flap. Clinical application of these findings, as well as the need for further studies, are discussed.
灌注冲洗在实验性和临床皮瓣中的益处长期以来一直存在争议。通过用UW溶液（一种最近开发的高分子量器官保存介质）灌注缺血大鼠带蒂皮瓣，结果显示，与未处理的对照皮瓣相比，处理后的皮瓣临界缺血时间增加了170%。本研究使用了60只大鼠。掀起一个基于腹壁浅动脉和静脉的3×6厘米单侧腹部皮瓣。将皮瓣分为三组：第1组（对照组——不进行灌注冲洗，n = 15）；第2组（乳酸林格液组——用乳酸林格液进行灌注冲洗，n = 15）；第3组（UW组——用UW溶液进行灌注冲洗，n = 30）。皮瓣经历不同时长的缺血，时长在8至30小时之间。第1组临床存活50%皮瓣的初始缺血时间为10小时，第2组为15小时，第3组为27小时。第1、2、3组皮瓣存活率之间的差异具有统计学意义（p <.0005）。通过将血管和实质细胞浸泡在不透性保存溶液中，推测细胞肿胀会受到抑制，从而显著提高皮瓣对热缺血的耐受性。此外，在查阅相关文献后发现，27小时的初始临界缺血时间是迄今为止正常体温实验大鼠带蒂皮瓣报道的最高值。讨论了这些发现的临床应用以及进一步研究的必要性。
