Kuzon W M, McKee N H, Fish J S, Pynn B R, Rosenblatt J D
Department of Surgery, University of Toronto, Ont., Canada.
J Hand Surg Am. 1988 Mar;13(2):263-73. doi: 10.1016/s0363-5023(88)80062-5.
Isometric contractile function was studied after recovery in free, vascularized muscle transfer subjected to graded periods of intraoperative ischemia. Fifteen dogs had orthotopic replantation of their left gracilis muscles, with intraoperative ischemia times grouped as 0 (n = 3), 1 to 2 (n = 3), 2 to 3 (n = 4), or 3 to 4 (n = 5) hours. After recovery (mean 61.8 weeks), isometric twitch and tetanic tension and fatigue measurements were made in the replants and in the contralateral, control gracilis. On the average, replants were found to produce significantly less twitch (0.32 +/- 0.13 versus 0.49 +/- 0.24 N/g) and 75 Hz tetanic tension (2.2 +/- 0.9 versus 3.4 +/- 0.5 N/g) than controls. However, in several individual replants, 100% of control maximal tetanic tension was observed. Intraoperative ischemia time of up to 4 hours was not correlated with functional return. It is concluded that (1) full recovery is possible after free muscle transfer; (2) intraoperative ischemia, if less than 4 hours long, is not the primary determinant of functional recovery; and (3) factors besides intraoperative ischemia must be operative in producing the variability in recovery seen in this setting.
对接受不同时长术中缺血的游离带血管肌肉移植术后恢复的等长收缩功能进行了研究。15只犬进行了左股薄肌原位再植，术中缺血时间分为0小时（n = 3）、1至2小时（n = 3）、2至3小时（n = 4）或3至4小时（n = 5）。恢复后（平均61.8周），对再植肌肉和对侧对照股薄肌进行等长抽搐、强直张力和疲劳测量。平均而言，发现再植肌肉产生的抽搐（0.32±0.13对0.49±0.24 N/g）和75 Hz强直张力（2.2±0.9对3.4±0.5 N/g）明显低于对照。然而，在一些个体再植肌肉中，观察到了100%的对照最大强直张力。长达4小时的术中缺血时间与功能恢复无关。得出的结论是：（1）游离肌肉移植后完全恢复是可能的；（2）如果术中缺血时间少于4小时，它不是功能恢复的主要决定因素；（3）除术中缺血外，其他因素必定在导致该情况下所见恢复差异方面起作用。
