Hirigoyen M B, Zhang W, Gordon R E, Prabhat A, Urken M L, Weinberg H
Division of Plastic Surgery, Mount Sinai Hospital, New York, NY 10029-6574, USA.
Ann Plast Surg. 1995 Dec;35(6):612-9. doi: 10.1097/00000637-199512000-00010.
Microvascular thrombosis is known to play an important part in the cessation of flow seen in a flap following ischemia and revascularization. Its reversal, using thrombolytic therapy, is associated with higher rates of successful flap salvage. Although this procedure restores patency to the microcirculation, the damaged endothelial cell layer remains highly thrombogenic and a definite risk of rethrombosis exists in the early period of reperfusion. In an inferior epigastric flap model in a rat, we investigated the effect of additional heparin (subcutaneous and intravenous administration) following a standardized urokinase washout (100,000 iu) of the ischemic flaps. Flap survival was assessed at 1 week and morphological changes in the microcirculation were observed using electron microscopy. Results showed a significant increase in flap survival in the group receiving intravenous heparin following urokinase washout and suggest that systemic heparin may play a beneficial role in the early reperfusion period following thrombolytic flap salvage.
已知微血管血栓形成在缺血再灌注后皮瓣出现的血流停止过程中起重要作用。使用溶栓疗法逆转这种情况，与皮瓣成功挽救的更高几率相关。尽管此 procedure 可恢复微循环通畅，但受损的内皮细胞层仍具有高度血栓形成倾向，且在再灌注早期存在再次血栓形成的明确风险。在大鼠下腹壁皮瓣模型中，我们研究了在对缺血皮瓣进行标准化尿激酶冲洗（100,000国际单位）后额外给予肝素（皮下和静脉注射）的效果。在1周时评估皮瓣存活情况，并使用电子显微镜观察微循环的形态变化。结果显示，尿激酶冲洗后接受静脉肝素治疗的组皮瓣存活率显著提高，表明全身性肝素可能在溶栓挽救皮瓣后的早期再灌注期发挥有益作用。
