Ramon Y, Abramovich A, Shupak A, Ullmann Y, Moscona R A, Shoshani O, Peled I J
Israel Naval Medical Institute and the Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haifa.
Plast Reconstr Surg. 1998 Aug;102(2):416-22. doi: 10.1097/00006534-199808000-00019.
The single-pedicle transverse rectus abdominis myocutaneous (TRAM) flap is frequently associated with partial flap necrosis. Hyperbaric oxygen has previously been shown to increase the survival of skin flaps, although there has been no investigation of possible beneficial effects of hyperbaric oxygen on survival of the TRAM flap. The present study compares the effectiveness of hyperbaric oxygen therapy, normobaric 100% oxygen, a hyperbaric air-equivalent mixture, and no treatment at all (control group), in the prevention of TRAM flap necrosis in a rat model. Forty-eight animals were randomly assigned to one of the four above-mentioned groups. The surviving area of the flap was evaluated 7 days after surgery. The hyperbaric oxygen treatment protocol consisted of five 9-minute sessions breathing 100% oxygen at a pressure of 2.5 atmospheres absolute during the first 48 hours, starting within 1 hour of surgery. The areas of surviving skin paddles ranged from 38.5 percent in the control group to 52.5 percent in the group treated with hyperbaric oxygen. One-way analysis of variance indicated that flap area survival was significantly greater in the hyperbaric oxygen group (F = 2.69, p = 0.05). Tukey's pairwise comparison and the two-sample t test indicated that the group treated with hyperbaric oxygen differed significantly from the control group (Tukey's critical value = 3.8, rejection level = 0.05, t test p = 0.01). Our results suggest that the hyperbaric oxygen treatment protocol used improves survival in the rat TRAM flap. However, the optimal treatment protocol to achieve this objective even in the rat seems to be variable, and further studies are required before extrapolating these data to human applications.
单蒂腹直肌肌皮（TRAM）瓣常伴有部分瓣坏死。高压氧先前已被证明可提高皮瓣的存活率，尽管尚未研究高压氧对TRAM瓣存活可能产生的有益作用。本研究比较了高压氧疗法、常压100%氧、高压空气等效混合物以及不进行任何治疗（对照组）在大鼠模型中预防TRAM瓣坏死的效果。48只动物被随机分配到上述四组中的一组。术后7天评估皮瓣的存活面积。高压氧治疗方案包括在术后1小时内开始的头48小时内进行5次9分钟的疗程，呼吸2.5绝对大气压下的100%氧。存活皮瓣的面积范围从对照组的38.5%到高压氧治疗组的52.5%。单因素方差分析表明，高压氧组的皮瓣面积存活率显著更高（F = 2.69，p = 0.05）。Tukey成对比较和双样本t检验表明，高压氧治疗组与对照组有显著差异（Tukey临界值 = 3.8，拒绝水平 = 0.05，t检验p = 0.01）。我们的结果表明，所采用的高压氧治疗方案可提高大鼠TRAM瓣的存活率。然而，即使在大鼠中实现这一目标的最佳治疗方案似乎也存在变数，在将这些数据外推至人类应用之前还需要进一步研究。
