Lepore D A, Knight K R, Bhattacharya S, Ritz M, Robbins S P, Sieg P, Morrison W A, O'Brien B M
Microsurgery Research Centre, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Microsurgery. 1994;15(10):685-92. doi: 10.1002/micr.1920151005.
The chief aim of this study was to maximize flap survival by counteracting the pathophysiological changes occurring during ischemia-reperfusion. Rabbit epigastric skin flaps given 21 hours of ischemia were infused intra-arterially with selected drugs at the start of reperfusion. Compared with control infused ischemic flaps, which had a 33% survival rate on day 7 post-ischemia, significant improvement was found with vasodilators nitrendipine (61%) and prostacyclin (65%) and the thrombolytic agent urokinase (65%); marginal improvement with the free radical scavenger desferrioxamine (53%); but no change with streptokinase (44%), heparin (21%), and ATP-MgCl2 (35%). A drug mixture comprising all of these agents except streptokinase and urokinase produced 87% survival, suggesting an additive effect. Biochemical assays on skin homogenates and blood implicated oxygen free radicals, neutrophil infiltration, and thromboxane in flap failure. These results imply that multiple factors are responsible for ischemic flap failure and that a mixture of drugs needs to be infused to counteract all of the detrimental changes.
本研究的主要目的是通过对抗缺血再灌注期间发生的病理生理变化，使皮瓣存活率最大化。在再灌注开始时，对经历21小时缺血的兔腹壁皮瓣进行动脉内输注选定药物。与对照输注的缺血皮瓣相比，缺血后第7天的存活率为33%，血管扩张剂尼群地平（61%）、前列环素（65%）和溶栓剂尿激酶（65%）有显著改善；自由基清除剂去铁胺（53%）有轻微改善；但链激酶（44%）、肝素（21%）和ATP - MgCl2（35%）无变化。除链激酶和尿激酶外，包含所有这些药物的混合物皮瓣存活率达87%，提示有相加作用。对皮肤匀浆和血液的生化分析表明，氧自由基、中性粒细胞浸润和血栓素与皮瓣坏死有关。这些结果表明，多种因素导致缺血皮瓣坏死，需要输注药物混合物来对抗所有有害变化。
