Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
J Surg Res. 2012 Nov;178(1):452-9. doi: 10.1016/j.jss.2012.03.051. Epub 2012 Apr 21.
Devastating extremity injuries are prevalent but most often survivable on the modern battlefield. The complexity of these injuries requires advanced methods of reconstruction. This study is designed to validate the feasibility of gracilis myocutaneous flap transplantation via microvascular free tissue transfer in a porcine model. This model will facilitate study of autotransplant physiology as well as vascularized composite allotransplantation as an evolving method for reconstructing previously nonreconstructable injuries.
A donor gracilis myocutaneous flap is procured from Yorkshire swine. The right external carotid artery and internal jugular vein are prepared as the recipient axis for microvascular anastomoses. Group 1 undergoes immediate microvascular anastomosis with resultant 1-h ischemic period. Group 2 undergoes delayed anastomosis with 3-h ischemic period. Markers of ischemia-reperfusion injury are evaluated after anastomosis and on postoperative days 1, 2, 7, and 14.
A novel porcine model for microvascular composite tissue transplantation is demonstrated. Ischemia period-dependent elevations in circulating biomarkers (lactate dehydrogenase [LDH], creatine kinase [CK], and aspartate transaminase [AST]) demonstrate the effects of prolonged ischemia. Both groups showed marked LDH elevation without significant statistical intergroup difference (P=0.250). The difference in CK and AST levels at 24h showed strong significance (P<0.0001).
A novel method of vascularized gracilis myocutaneous flap transplantation was validated in the Yorkshire swine. Assays for skeletal muscle tissue injury (LDH, CK, and AST) showed ischemia period-dependent response providing assessment of ischemia-reperfusion injury at the cellular level. Subsequent studies will evaluate agents that mitigate ischemia-reperfusion injury and transition these findings to potentiate vascularized composite allotransplantation.
毁灭性的四肢损伤在现代战场上很常见，但大多数情况下是可以存活的。这些损伤的复杂性需要采用先进的重建方法。本研究旨在通过微血管游离组织移植验证猪模型中股薄肌肌皮瓣移植的可行性。这种模型将有助于研究自体移植生理学以及作为重建以前不可重建损伤的一种新兴方法的血管化复合同种异体移植。
从约克郡猪中获取供体股薄肌肌皮瓣。准备右侧颈外动脉和颈内静脉作为微血管吻合的受体轴。第 1 组立即进行微血管吻合，导致 1 小时缺血期。第 2 组延迟吻合，缺血期 3 小时。吻合后和术后第 1、2、7 和 14 天评估缺血再灌注损伤的标志物。
展示了一种新的用于微血管复合组织移植的猪模型。与延长缺血相关的循环生物标志物（乳酸脱氢酶 [LDH]、肌酸激酶 [CK] 和天冬氨酸转氨酶 [AST]）升高表明了缺血的影响。两组均显示出明显的 LDH 升高，但无统计学组间差异（P=0.250）。24 小时时 CK 和 AST 水平的差异具有显著意义（P<0.0001）。
在约克郡猪中验证了一种新的血管化股薄肌肌皮瓣移植方法。用于骨骼肌组织损伤的测定（LDH、CK 和 AST）显示出与缺血时间相关的反应，为细胞水平的缺血再灌注损伤提供了评估。随后的研究将评估减轻缺血再灌注损伤的药物，并将这些发现转化为增强血管化复合同种异体移植的潜力。
