Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea.
Department of Anesthesiology and Pain Medicine, Korean University Medical Center, Korea.
J Plast Reconstr Aesthet Surg. 2019 Oct;72(10):1653-1660. doi: 10.1016/j.bjps.2019.06.009. Epub 2019 Jun 27.
During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation.
The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute).
Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001).
Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.
在重建性外科手术中，经常使用全身性血管加压素来维持正常血压。然而，关于血管加压素对皮瓣循环的药理作用存在疑问。许多整形外科医生担心药物的血管收缩作用会导致皮瓣循环受损。然而，也存在相反的观点，即血管活性药物引起的平均动脉压升高可能会改善皮瓣灌注。本研究旨在评估常用血管加压素对皮瓣循环的影响。
在五只雌性猪（38.2∼40.7kg）中掀起垂直腹直肌肌皮瓣（VRAM）岛瓣。通过颈动脉导管连续测量血流动力学参数。应用双向跨音速血管多普勒流量探头和激光多普勒灌注监测仪（LDPM）单元，记录静脉注射多巴胺（3、5、10μg/kg/min）、多巴酚丁胺（1.25、2.5、5μg/kg/min）和去甲肾上腺素（0.05、0.1、0.2μg/kg/min）后蒂动脉血流和微血管灌注的连续变化。
微血管灌注和蒂血流量通常与平均动脉压成正比，三种血管加压素均改善皮瓣灌注和蒂血流量，无不良影响。去甲肾上腺素显示出最高的微血管灌注，而多巴酚丁胺显示出最高的蒂血流量。平均血压是唯一对微血管灌注和蒂血流量有统计学意义的影响因素（p<0.0001）。
我们的结果强烈表明，前三种血管加压素可用于皮瓣手术而不会恶化，维持足够的全身血压对于良好的皮瓣循环至关重要。
