Coelho da Mota Denise S, Sicuro Fernando L, Resende Angela C, De Moura Roberto S, Bottino Daniel A, Bouskela Eliete
Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
Laboratory of Clinical and Experimental Research in Vascular Biology, Department of Physiological Sciences, Institute of Biology, UERJ, Rio de Janeiro, Brazil.
J Surg Res. 2018 Aug;228:253-262. doi: 10.1016/j.jss.2018.03.014. Epub 2018 Apr 12.
Tissue necrosis caused by insufficient perfusion is a major complication in flap transfer. This study evaluated whether treatment with cilostazol or hydroalcoholic extract of seeds of Euterpe oleracea Mart. (açaí) protects the transverse rectus abdominis myocutaneous (TRAM) flap against ischemic damage in hamsters.
Fifty-four hamsters were divided into three oral treatment groups: placebo, açaí, or cilostazol. Caudally based, unipedicled TRAM flaps were raised, sutured back, classified into four vascular zones (I-IV), and evaluated for tissue viability, capillary blood flow (CBF), perfused vessel density (PVD), and microvascular flow index (MFI) by orthogonal polarization spectral imaging at three time points: immediately postoperatively (IPO), 24 h postoperatively (24hPO), and 7 d postoperatively (7POD).
Comparing to placebo, açaí increased PVD at IPO and açaí and cilostazol increased CBF and PVD at 24hPO in zone I; cilostazol increased CBF, PVD, and MFI at IPO, and CBF at 24hPO in zone II; açaí and cilostazol increased CBF at all time points and PVD and MFI at IPO and 24hPO in zone III; cilostazol increased CBF at IPO and 7POD, açaí increased CBF at 7POD, and both increased PVD and MFI at all time points in zone IV; and açaí and cilostazol increased the percentage of viable area in zones III and IV.
Açaí and cilostazol treatments had a protective effect against ischemic damage to TRAM flaps in hamsters, improving microvascular blood flow and increasing the survival of flap zones contralateral to the vascular pedicle (zones III and IV).
灌注不足导致的组织坏死是皮瓣移植中的主要并发症。本研究评估西洛他唑或巴西莓（Euterpe oleracea Mart.）种子水醇提取物治疗是否能保护仓鼠腹直肌横形肌皮瓣（TRAM皮瓣）免受缺血损伤。
54只仓鼠分为三个口服治疗组：安慰剂组、巴西莓组或西洛他唑组。掀起蒂在尾侧的单蒂TRAM皮瓣，缝合回原位，分为四个血管区（I-IV），并在三个时间点通过正交偏振光谱成像评估组织活力、毛细血管血流（CBF）、灌注血管密度（PVD）和微血管血流指数（MFI）：术后即刻（IPO）、术后24小时（24hPO）和术后7天（7POD）。
与安慰剂组相比，巴西莓在IPO时增加了PVD，在24hPO时巴西莓和西洛他唑增加了I区的CBF和PVD；西洛他唑在IPO时增加了CBF、PVD和MFI，在24hPO时增加了II区的CBF；巴西莓和西洛他唑在所有时间点均增加了CBF，在IPO和24hPO时增加了III区的PVD和MFI；西洛他唑在IPO和7POD时增加了CBF，巴西莓在7POD时增加了CBF，二者在所有时间点均增加了IV区的PVD和MFI；巴西莓和西洛他唑增加了III区和IV区的存活面积百分比。
巴西莓和西洛他唑治疗对仓鼠TRAM皮瓣缺血损伤具有保护作用，可改善微血管血流并增加血管蒂对侧皮瓣区（III区和IV区）的存活。
