Park Jin-Woo, Mun Goo-Hyun
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, South Korea.
Microsurgery. 2018 Mar;38(3):310-317. doi: 10.1002/micr.30286. Epub 2017 Dec 27.
First-line antihypertensive drugs include calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. In this study, we compared the effects of antihypertensive drugs on the survival of perforator flaps in a rat model.
Fifty normotensive rats were randomly divided into five groups, with 10 rats in each group. Four different antihypertensive drugs were given via oral gavage for 7 days: group I: 1.5 mg/kg amlodipine; group II: 15 mg/kg captopril; group III: 15 mg/kg losartan; group IV: 7 mg/kg dichlozid; and group V: saline. An 8 × 10-cm-sized extended dorsal island skin flap based on the unilateral deep circumflex iliac artery perforator was elevated and fixed in place. At postoperative day 7, evaluation of viable flap area, edema measurement, and histological analysis were conducted.
No significant difference in systolic blood pressure was observed preoperatively between any of the groups. The mean flap survival area was 81.54 ± 6.71, 55.76 ± 21.01, 48.45 ± 13.72, 58.14 ± 16.96, and 67.99 ± 10.68% in groups I, II, III, IV, and V, respectively. It was significantly increased in group I (P = .007) and decreased in group III (P = .011) compared with the control group. The mean full-thickness necrosis area was significantly increased in group III (P = .024) compared to the control group.
Angiotensin receptor blockers adversely affected the survival of perforator flaps, while calcium channel blockers increased it. These results suggest that the regimen of antihypertensive drugs may need to be carefully selected for patients undergoing perforator flap reconstruction.
一线抗高血压药物包括钙通道阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和利尿剂。在本研究中，我们在大鼠模型中比较了抗高血压药物对穿支皮瓣存活的影响。
50只血压正常的大鼠随机分为五组，每组10只。通过灌胃给予四种不同的抗高血压药物，持续7天：第一组：1.5mg/kg氨氯地平；第二组：15mg/kg卡托普利；第三组：15mg/kg氯沙坦；第四组：7mg/kg双氢氯噻嗪；第五组：生理盐水。基于单侧旋髂深动脉穿支掀起一个8×10cm大小的扩大背侧岛状皮瓣并固定在位。术后第7天，进行皮瓣存活面积评估、水肿测量和组织学分析。
术前各组之间收缩压无显著差异。第一、二、三、四和五组的平均皮瓣存活面积分别为81.54±6.71%、55.76±21.01%、48.45±13.72%、58.14±16.96%和67.99±10.68%。与对照组相比，第一组显著增加（P = 0.007），第三组显著降低（P = 0.011）。与对照组相比，第三组的平均全层坏死面积显著增加（P = 0.024）。
血管紧张素受体阻滞剂对穿支皮瓣存活有不利影响，而钙通道阻滞剂则可提高其存活率。这些结果表明，对于接受穿支皮瓣重建的患者，可能需要仔细选择抗高血压药物治疗方案。
