Liao Yi, Tong Ting-hui, Wang Tai-ping, Han Yin
Department of Plastic Surgery and Burns, the Affiliated Hospital of Luzhou Medical College, Luzhou 646000, China.
Zhonghua Shao Shang Za Zhi. 2011 Jun;27(3):215-7.
To observe the effect of local injection of recombinant hirudin on survival of skin flaps with venous congestion in a rabbit model.
Eighteen healthy rabbits were enrolled and divided into heparin-treatment (HT), recombinant hirudin treatment (RHT) and control (C) groups according to the random number table, with 6 rabbits in each group. After intravenous anesthesia with 20 g/L pentobarbital sodium, model of skin flaps with venous congestion in the size of 6 cm × 3 cm was reproduced in the dorsal side of left ear of each rabbit, in which central artery of ear served as the only blood supply, and a pedicle of 1 cm in width including central vessel of ear and its accompanying nerves as the only venous return pathway. Each flap in RHT, HT, C groups was respectively given 1 mL recombinant hirudin (1 U), low-molecular-weight heparin (625 U), and isotonic saline via multi-point and homogenous injection, then they were sutured in site. Appearance and survival rate of the flaps were observed after operation. Specimens of the distal part of flaps were harvested for determination of thromboxane B2 (TXB2) on post operation day (POD) 1, 3, 5, 7. Data were processed with one-way analysis of variance and t test.
Rabbit model of skin flaps with venous congestion was reproduced successfully. Obvious hair loss was observed in completely necrotic parts of flap in each group. Obvious edema was observed in all flaps with venous congestion at distal site. The color of flaps in HT and RHT groups were lighter as compared with that in C group, and apparent hematoma of flap was observed in 1 rabbit of RHT group, 2 rabbits of HT group, 4 rabbits of C group on POD 1. The survival rate of flap in HT and RHT groups was respectively (92.3 ± 1.7)% and (94.8 ± 1.9)%, both higher than that in C group [(77.9 ± 1.2)%, F = 191.29, P < 0.05]. There was no statistical difference in survival rate of flap between HT group and RHT group (t = 2.75,P > 0.05). The content of TXB2 in HT and RHT groups on POD 3, 5 was respectively lower than that in C group (with t value from 6.68 to 30.55, P values all below 0.01), but there was no statistical difference between HT and RHT groups (with t value respectively 1.22, 6.44, P values all above 0.05).
Local injection of low-molecular-weight heparin or recombinant hirudin can significantly ameliorate venous congestion of skin flap in rabbit ear, and improve its survival rate.
观察局部注射重组水蛭素对兔耳静脉淤血皮瓣存活的影响。
选取18只健康家兔，按随机数字表法分为肝素治疗组（HT）、重组水蛭素治疗组（RHT）和对照组（C），每组6只。用20 g/L戊巴比妥钠静脉麻醉后，在每只家兔左耳背侧制作6 cm×3 cm大小的静脉淤血皮瓣模型，以耳中央动脉为唯一血供，以宽1 cm包含耳中央血管及其伴行神经的蒂部为唯一静脉回流途径。RHT组、HT组、C组皮瓣分别多点均匀注射1 mL重组水蛭素（1 U）、低分子肝素（625 U）、等渗盐水，然后原位缝合。术后观察皮瓣外观及存活率。于术后第1、3、5、7天切取皮瓣远端标本测定血栓素B2（TXB2）。数据采用单因素方差分析和t检验处理。
成功复制兔耳静脉淤血皮瓣模型。各组皮瓣完全坏死部位均可见明显脱毛。所有静脉淤血皮瓣远端均可见明显水肿。HT组和RHT组皮瓣颜色较C组浅，术后第1天RHT组有1只家兔、HT组有2只家兔、C组有4只家兔出现明显皮瓣血肿。HT组和RHT组皮瓣存活率分别为（92.3±1.7）%和（94.8±1.9）%，均高于C组[（77.9±1.2）%，F = 191.29，P < 0.05]。HT组与RHT组皮瓣存活率差异无统计学意义（t = 2.75，P > 0.05）。HT组和RHT组术后第3、5天TXB2含量均低于C组（t值为6.68～30.55，P值均< 0.01），但HT组与RHT组之间差异无统计学意义（t值分别为1.22、6.44，P值均> 0.05）。
局部注射低分子肝素或重组水蛭素均可显著改善兔耳皮瓣静脉淤血，提高其存活率。
