Bschorer R, Frerich B, Wolburg H, Gehrke G, Schwenzer N
Maxillofacial Surgery Clinic, Eberhard-Karls-University of Tübingen, Germany.
J Craniomaxillofac Surg. 1993 Jul;21(5):192-8. doi: 10.1016/s1010-5182(05)80480-9.
Reports from the literature demonstrated an early occlusive thrombosis rate of microvascular anastomoses of up to 25%. In order to reduce free flap failure due to kinking and pressure in the region of the anastomosis, fibrin sealing of microvascular anastomosis was recommended in previous studies. However, it is well accepted that haemostasis is activated by vascular wall injuries (lesions of the endothelial layer). For that reason, a fast re-endothelialisation of the inner surface of the anastomosis is thought to reduce early occlusive thrombosis and, subsequent, free flap failure. To clarify whether application of fibrin adhesives exert any effect on microvascular anastomoses, we constructed 84 anastomoses in rat arteries applying sealant or non-sealant in randomized order. At certain time intervals, arteries operated on were removed and histologically analyzed. Early complete endothelial regeneration, 4 days after surgery, was observed in the unsealed anastomosis group, whereas sealed anastomosis showed a complete re-endothelialisation only after 7 days. These observations may be explained by a reduced multiplication rate and migration speed (0.3 mm/day) of endothelial cells during the first 3 days (unsealed anastomosis: 0.63 mm/day). In addition, in sealed anastomoses a higher incidence of media necrosis was found (60.7% vs 49.3% in the unsealed group). These histological changes were confirmed by scanning and transmission electron microscopy.
文献报道显示，微血管吻合口的早期闭塞性血栓形成率高达25%。为了减少因吻合口区域扭结和受压导致的游离皮瓣失败，以往的研究推荐对微血管吻合口进行纤维蛋白封闭。然而，众所周知，血管壁损伤（内皮细胞层损伤）会激活止血过程。因此，人们认为吻合口内表面的快速再内皮化可减少早期闭塞性血栓形成，进而减少游离皮瓣失败。为了阐明纤维蛋白粘合剂的应用是否对微血管吻合有任何影响，我们以随机顺序在大鼠动脉中构建了84个吻合口，分别应用密封剂或非密封剂。在特定时间间隔，取出手术操作的动脉并进行组织学分析。在未密封的吻合口组中，术后4天观察到早期完全内皮再生，而密封的吻合口仅在7天后才出现完全再内皮化。这些观察结果可能是由于内皮细胞在前3天的增殖率和迁移速度降低（未密封的吻合口：0.63毫米/天，密封的吻合口：0.3毫米/天）。此外，在密封的吻合口中发现中膜坏死的发生率更高（60.7%，未密封组为49.3%）。这些组织学变化通过扫描电子显微镜和透射电子显微镜得到证实。
