Li X, Cooley B C, Gould J S
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee 53226.
J Hand Surg Am. 1993 Jul;18(4):629-34. doi: 10.1016/0363-5023(93)90306-N.
Rat muscle flaps (cutaneous maximus) were subjected to 4 hours of room-temperature ischemia followed by 44 hours of cold (4 degrees C) ischemia before transplantation. Experimental flaps underwent a 15-minute ex vivo perfusion with heparinized-citrated blood between the warm and cold ischemic treatments; control flaps were not perfused. After 1 or 48 hours of recirculation, muscle dehydrogenase activity was found to be higher in the perfused flaps, indicating better muscle viability. Lipid peroxidation was lower in the perfused flaps, indicating a reduction in free radical generation. Histologic assessment revealed that perfused flaps underwent less injury than unperfused flaps. The findings of this study indicate that replacement of standing blood with anticoagulated blood, with the use of a brief ex vivo perfusion protocol, has a significant protective effect against ischemic injury. The experimental design mimics a realistic point of intervention and presents a paradigm for the clinical treatment of amputated extremities.
大鼠肌肉瓣（臀大肌瓣）在移植前先经历4小时的室温缺血，然后再进行44小时的冷（4℃）缺血。实验瓣在温缺血和冷缺血处理之间用肝素化枸橼酸盐血进行15分钟的离体灌注；对照瓣未进行灌注。再灌注1小时或48小时后，发现灌注瓣的肌肉脱氢酶活性较高，表明肌肉活力更好。灌注瓣中的脂质过氧化水平较低，表明自由基生成减少。组织学评估显示，灌注瓣比未灌注瓣受到的损伤更小。本研究结果表明，采用简短的离体灌注方案，用抗凝血液替代停滞血液，对缺血性损伤具有显著的保护作用。该实验设计模拟了一个现实的干预点，并为截肢肢体的临床治疗提供了一个范例。
