Warner K G, Durham-Smith G, Butler M D, Attinger C E, Upton J, Khuri S F
Department of Surgery, Brockton and West Roxbury Veterans Administration Medical Center, MA 02132.
Ann Plast Surg. 1989 Feb;22(2):108-16. doi: 10.1097/00000637-198902000-00005.
Clinical measures often fail to detect early tissue ischemia in inadequately perfused flaps. This study investigates the application of a new pH electrode system to monitor tissue metabolism continuously in porcine and human musculocutaneous flaps. Bilateral rectus abdominis flaps based on the deep inferior epigastric pedicle were elevated in eight mixed-breed pigs. Tissue pH was measured in the subcutaneous and muscular layers with miniature glass-tip electrodes. The deep inferior epigastric artery and vein were serially and then concomitantly occluded for 20-minute periods. The decrease in tissue pH was greater following either arterial or pedicle occlusion (each 0.21 +/- 0.03 units) when compared with venous occlusion (0.10 +/- 0.02 units; p less than 0.02). Changes in muscle and subcutaneous hydrogen ion concentration were similar during arterial and venous occlusions (probability not significant). Measurement of subcutaneous pH appears to be a reliable experimental and clinical physiological tool for detecting early tissue ischemia in reconstructive flaps.
临床检测方法常常无法在灌注不足的皮瓣中检测到早期组织缺血。本研究调查了一种新型pH电极系统在猪和人肌皮瓣中连续监测组织代谢的应用。在八只杂种猪身上掀起以腹壁下深血管为蒂的双侧腹直肌皮瓣。用微型玻璃尖端电极测量皮下和肌肉层的组织pH值。依次阻断腹壁下深动脉和静脉，然后同时阻断20分钟。与静脉阻断（0.10±0.02个单位；p<0.02）相比，动脉或蒂部阻断后组织pH值的下降幅度更大（均为0.21±0.03个单位）。在动脉和静脉阻断期间，肌肉和皮下氢离子浓度的变化相似（概率无统计学意义）。测量皮下pH值似乎是检测重建皮瓣早期组织缺血的一种可靠的实验和临床生理学工具。
