Halim Ahmad Sukari, Wan Ahmad Kamal Wan Syazli Rodzaia, Noor Norizal Mohd, Abdullah Shafie
Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Arch Plast Surg. 2013 Nov;40(6):687-96. doi: 10.5999/aps.2013.40.6.687. Epub 2013 Nov 8.
Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published.
Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed.
The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups.
In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.
缺血预处理已被证明可改善心脏、大脑、肺、肝脏、空肠、皮肤和肌肉组织的缺氧耐受性结局。然而，迄今为止，尚未有关于缺血预处理对带血管骨移植影响的报道。
将16只兔子分为四组，缺血时间分别为2小时、6小时、14小时和18小时。每组一半的兔子接受缺血预处理。骨肌皮瓣由胫骨组成，其上的肌肉和皮肤被掀起。缺血预处理技术包括用血管夹夹闭蒂部3个周期，每个周期10分钟。然后在术后第1周、第2周、第4周和第6周对兔子进行系列X线平片和计算机断层扫描成像。之后，处死所有兔子并进行组织学检查。
结果显示，对于皮瓣和骨移植的临床分析，预处理组显示出更好的存活率。在X线平片中，除了两只术中缺血时间为6小时的未预处理兔子外，所有兔子在第4周开始显示早期骨痂形成。计算机断层扫描结果显示，除18小时组外，预处理组在所有缺血时间下骨痂形成更多。组织学结果与放射学结果相关。两组之间的差异无统计学意义。
总之，缺血预处理提高了皮瓣的存活率，并增加了带血管骨移植愈合过程中的骨痂形成。
