Cooley B C, Groner J P, Hoer S R, Dollinger B M, Hanel D P
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee 53226.
Microsurgery. 1991;12(2):86-8. doi: 10.1002/micr.1920120206.
An experimental model was developed combining arterial trauma with island flap creation using the rat groin flap system. Flap arteries were subjected to crush/avulsion injuries with subsequent microvascular repair. A second series involved resection 4 hr after thrombosis of injured flap arteries and interpositional vein grafting to reestablish circulation. A single bolus of systemic heparin was administered to half of the animals from each series on a blinded, randomized basis. Arterial patency at 7 days correlated with flap survival. There was no case of partial flap loss. Patencies improved in the first series from 31% to 71% with heparin administration (P less than 0.05) and from 58% to 90% in the second (not significantly different). A third series involving immediate resection of traumatized vessel and vein graft replacement achieved a patency of 92% (without heparinization). These results support the value of replacement of all traumatized arterial tissue with vein grafts and indicate the efficacy of systemic heparin (in single bolus) for enhancing the likelihood of maintaining patency. Furthermore, it is suggested that the occurrence of a thrombogenic site in the arterial inflow to a region of dependent tissue does not lead to partial tissue loss, and thus thromboembolic events may not be responsible for this clinical phenomenon.
利用大鼠腹股沟皮瓣系统，建立了一种将动脉损伤与岛状皮瓣制作相结合的实验模型。对皮瓣动脉进行挤压/撕脱伤，随后进行微血管修复。第二个系列实验是在受伤皮瓣动脉血栓形成4小时后进行切除，并进行静脉移植以重建血液循环。对每个系列中的一半动物进行盲法随机分组，给予单次大剂量全身肝素治疗。7天时的动脉通畅情况与皮瓣存活相关。没有出现部分皮瓣坏死的情况。在第一个系列实验中，给予肝素后动脉通畅率从31%提高到71%（P<0.05），在第二个系列中从58%提高到90%（无显著差异）。第三个系列实验是立即切除受创伤的血管并进行静脉移植置换，动脉通畅率达到92%（未进行肝素化）。这些结果支持了用静脉移植置换所有受创伤动脉组织的价值，并表明全身肝素（单次大剂量）在提高维持通畅可能性方面的有效性。此外，研究表明，依赖组织区域动脉流入中血栓形成部位的出现不会导致部分组织丢失，因此血栓栓塞事件可能不是这种临床现象的原因。
