Eaton C J, Mitchell G M, Crowe D M, Morrison W A, O'Brien B M
Microsurgery Research Centre, St. Vincent's Hospital, Melbourne, Australia.
Plast Reconstr Surg. 1995 Aug;96(2):413-20. doi: 10.1097/00006534-199508000-00024.
Avulsion injuries have a poor prognosis for survival in clinical replantation surgery. Arterial thrombosis is the most significant factor contributing to avulsion replant failure, and severe arterial damage has been observed with this injury. However, patency rates of experimentally avulsed arteries repaired immediately are much higher than in the clinical situation. This paper evaluates the effect of an added component--ischemia--on the patency of experimentally avulsed arteries. All avulsions seen clinically are subject to some degree of ischemia prior to replantation. Ninety rabbits had both femoral arteries avulsed under general anesthesia. A 6.5-cm graft was harvested from the left distal femoral artery. In 20 rabbits (group 1: 0 hours of ischemia) the graft was immediately inserted into the defect in the right femoral artery. Sixty rabbits (20 grafts per group) had their grafts stored at 4 degrees C for either 10 hours (group 2), 18 hours (group 3), or 24 hours (group 4) and reinserted into the right femoral artery in a second operation. Patency was assessed 3 weeks after reinsertion. Groups 1 and 2 maintained high patency rates (85 percent); however, group 3 (70 percent) and group 4 (45 percent) had lower patency rates than group 1, with a significant difference between groups 1 and 4 (p < 0.01). In a fifth group (10 grafts), avulsed 24-hour ischemic grafts were hydrodilated prior to reinsertion. The patency rate of this group increased significantly (90 percent) compared with group 4 (p < 0.005).
These experiments suggest that a combination of avulsion injury and ischemia time is responsible for the poor clinical results of avulsion replantations.
在临床再植手术中，撕脱伤的存活预后较差。动脉血栓形成是导致撕脱再植失败的最重要因素，并且在这种损伤中已观察到严重的动脉损伤。然而，实验性立即修复的撕脱动脉的通畅率远高于临床情况。本文评估了一个附加因素——缺血——对实验性撕脱动脉通畅率的影响。临床上所见的所有撕脱伤在再植前都会经历一定程度的缺血。90只兔子在全身麻醉下双侧股动脉被撕脱。从左股动脉远端获取一段6.5厘米的移植物。20只兔子（第1组：缺血0小时）的移植物立即插入右股动脉的缺损处。60只兔子（每组20个移植物）将其移植物在4℃下保存10小时（第2组）、18小时（第3组）或24小时（第4组），并在第二次手术中重新插入右股动脉。重新插入3周后评估通畅情况。第1组和第2组保持较高的通畅率（85%）；然而，第3组（70%）和第4组（45%）的通畅率低于第1组，第1组和第4组之间存在显著差异（p<0.01）。在第五组（10个移植物）中，24小时缺血的撕脱移植物在重新插入前进行了液压扩张。与第4组相比，该组的通畅率显著提高（90%）（p<0.005）。
这些实验表明，撕脱伤和缺血时间的综合作用是撕脱再植临床效果不佳的原因。
