Reichenberger Matthias A, Keil Holger, Mueller Wolf, Herold-Mende Christel, Meirer Romed, Gebhard Martha Maria, Germann Günter, Engel Holger
Department of Plastic and Hand Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
Ann Plast Surg. 2011 Nov;67(5):539-44. doi: 10.1097/SAP.0b013e3182085880.
Enhancement of flap survival through extracorporeal shock wave treatment (ESWT) is a promising new technique; however, no attempt has been made to define the optimal time point and frequency of ESWT to optimize treatment with ESWT for ischemic indications. Twenty-eight male Wistar rats were randomized into 4 groups and an oversized, random-pattern flap was raised and reattached in place in each animal. ESWT was applied 7 days before (group E7) or immediately after the surgical intervention (group E0). The third group was treated with ESWT 7 days before and additionally immediately after the operation (group E7/0). The fourth group served as a control group and did not receive any ESWT (group C). Seven days after flap harvest the results of flap survival, perfusion, microvessel density, and vascular endothelial growth factor concentrations were assessed. Flap survival was significantly increased in all ESWT groups as compared with the control group. The groups (E7 and E0) that received ESWT pre- or postoperatively showed a significant increase in flap perfusion and microvessel density. Combined pre- and postoperative ESWT application (group E0/E7) did not demonstrate a cumulative effect in any evaluation. In this study, we were be able to prove the effectiveness of ESWT in the protection of ischemic tissue flaps. This study suggests that single postoperative application is the most efficacious protocol for clinical applications of ESWT in the treatment of ischemic tissue.
通过体外冲击波治疗（ESWT）提高皮瓣存活率是一项很有前景的新技术；然而，尚未有人尝试确定ESWT的最佳时间点和频率，以优化针对缺血适应症的ESWT治疗。将28只雄性Wistar大鼠随机分为4组，在每只动物身上掀起一个超大的随意型皮瓣并原位重新附着。在手术干预前7天（E7组）或手术后立即（E0组）进行ESWT治疗。第三组在术前7天接受ESWT治疗，并在术后立即额外进行一次（E7/0组）。第四组作为对照组，不接受任何ESWT治疗（C组）。皮瓣切取7天后，评估皮瓣存活率、灌注情况、微血管密度和血管内皮生长因子浓度。与对照组相比，所有ESWT组的皮瓣存活率均显著提高。术前或术后接受ESWT治疗的组（E7组和E0组）皮瓣灌注和微血管密度显著增加。术前和术后联合应用ESWT（E0/E7组）在任何评估中均未显示出累积效应。在本研究中，我们能够证明ESWT在保护缺血组织皮瓣方面的有效性。本研究表明，术后单次应用是ESWT临床治疗缺血组织最有效的方案。
