Wang Shi-Ping, Lan Zhi-Yong, Xia Wei, Zhao Xi, Ma Ge-Jia, Liu Bei, Pan Bao-Hua, Guo Shu-Zhong
From the Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
Ann Plast Surg. 2014 Jan;72(1):94-9. doi: 10.1097/SAP.0b013e318255a3eb.
A lot of methods have been intensively investigated to improve random skin flap survival. Decreasing inflammation and alleviating tissue injury have been reported to be effective in improving survival ratio. Vasonatrin peptide (VNP) is a chimera of atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP). The current study demonstrates that VNP possesses the venodilating actions of CNP, the natriuretic actions of ANP, and the unique arterial vasodilating actions not associated with either ANP or CNP. However, its effects on skin flap survival have not been previously reported.
Sprague-Dawley rats, weighing 220 to 260 g, were randomly divided into 2 groups, namely, the VNP-treated group and the control group. Rectangular random dorsal skin flaps measuring 3 × 9 cm including the panniculus carnosus were elevated, then the flaps were sutured into their original places. In the VNP group, 0.1 mg/kg of VNP was administered intravenously (IV) after surgery and then daily for 3 days. In the control group, 1 mL/kg of saline was administered IV after surgery and then daily for 3 days. To observe the effects of VNP, blood perfusion, histopathological examination, the inflammatory mediators (tumor necrosis factor α, interleukin 1β, and interferon γ), and biochemical analysis (malondialdehyde, glutathione, and myeloperoxidase) were detected and the flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area.
The viability measurements showed the percentage of flap survival was increased in the VNP-treated group (76.53% ± 6.36%) as compared with the control group (61.12% ± 4.92%) (P < 0.05), and the histological and biochemical assays corroborated the data. The blood perfusion of flaps in the VNP-treated group was higher than the control group (P < 0.05). The inflammatory mediators (tumor necrosis factor α, interleukin 1β, and interferon γ) were significantly lower in the VNP-treated group than the control group (P < 0.05).
This study found that VNP, which could elevate the tissue blood perfusion and mitigate the tissue damage and inflammatory reaction, is associated with a higher percentage of survival random pattern skin flap area.
为提高随意皮瓣的存活率,人们对多种方法进行了深入研究。据报道,减轻炎症和缓解组织损伤对提高存活率有效。血管钠肽(VNP)是心房利钠肽(ANP)和C型利钠肽(CNP)的嵌合体。目前的研究表明,VNP具有CNP的静脉舒张作用、ANP的利钠作用以及与ANP或CNP均无关的独特动脉舒张作用。然而,其对皮瓣存活的影响此前尚未见报道。
将体重220至260克的Sprague-Dawley大鼠随机分为2组,即VNP治疗组和对照组。掀起包含深筋膜的3×9厘米矩形随意背部皮瓣,然后将皮瓣缝合回原位。在VNP组中,术后静脉注射(IV)0.1毫克/千克VNP,然后连续3天每日注射一次。在对照组中,术后静脉注射1毫升/千克生理盐水,然后连续3天每日注射一次。为观察VNP的作用,检测了血液灌注、组织病理学检查、炎症介质(肿瘤坏死因子α、白细胞介素1β和干扰素γ)以及生化分析(丙二醛、谷胱甘肽和髓过氧化物酶),并在术后7天通过测量坏死皮瓣面积和总皮瓣面积评估皮瓣活力。
活力测量显示,VNP治疗组的皮瓣存活百分比(76.53%±6.36%)高于对照组(61.12%±4.92%)(P<0.05),组织学和生化分析证实了该数据。VNP治疗组皮瓣的血液灌注高于对照组(P<0.05)。VNP治疗组的炎症介质(肿瘤坏死因子α、白细胞介素1β和干扰素γ)明显低于对照组(P<0.05)。
本研究发现,VNP可提高组织血液灌注,减轻组织损伤和炎症反应,与随意型皮瓣存活面积的较高百分比相关。