Costantino P D, Atiyah R A, Mico A S, Sisson G A
Department of Otolaryngology Head and Neck Surgery, Northwestern, University Medical School, Chicago, IL 60611.
Laryngoscope. 1988 Apr;98(4):377-81. doi: 10.1288/00005537-198804000-00003.
Carotid artery exposure and rupture is one of the most feared complications of head and neck surgery. The ideal method for preventing rupture of an exposed artery should be easy to perform, safe, effective and should spare local and regional flaps for later use in reconstruction. Isobutyl-2-cyanoacrylate (Bucrylate) is a commercially available compound that appears to meet these criteria. Test animals were divided into two groups. The carotid arteries of 12 dogs (group A) were exteriorized bilaterally and coated with Bucrylate unilaterally. Group B (four dogs) underwent the same procedure except that the vessels were bilaterally coated. Wounds were dressed twice daily with moist-to-dry gauze. No antibiotics were given. Nine of the 12 unprotected arteries in group A ruptured within 2 weeks, and one unprotected artery ruptured on postoperative day (POD) 29. Two dogs healed over both vessels. In group B, three dogs ruptured their arteries within 2 weeks. One dog healed over both vessels. Gross and histologic examination of the arteries showed a striking difference between coated and uncoated vessels. We believe that Bucrylate and cyanoacrylate adhesives hold promise in the clinical protection of exposed carotid arteries.
颈动脉暴露和破裂是头颈外科手术中最令人担忧的并发症之一。预防暴露动脉破裂的理想方法应操作简便、安全有效，且应保留局部和区域皮瓣以供后期重建使用。异丁基-2-氰基丙烯酸酯（丁酯）是一种市售化合物，似乎符合这些标准。将实验动物分为两组。12只狗（A组）的双侧颈动脉均被外置，其中一侧用丁酯覆盖。B组（4只狗）进行了相同的操作，只是双侧血管均被覆盖。伤口每天用湿-干纱布换药两次。未使用抗生素。A组12条未受保护的动脉中有9条在2周内破裂，1条未受保护的动脉在术后第29天破裂。2只狗的两条血管均愈合。在B组中，3只狗的动脉在2周内破裂。1只狗的两条血管均愈合。对动脉的大体和组织学检查显示，覆盖和未覆盖的血管之间存在显著差异。我们认为，丁酯和氰基丙烯酸酯粘合剂在临床保护暴露的颈动脉方面具有前景。
