Marek C A, Amiss L R, Morgan R F, Spotnitz W D, Drake D B
Department of Plastic Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Ann Plast Surg. 1998 Oct;41(4):415-9. doi: 10.1097/00000637-199810000-00011.
Topically applied bioadhesives and hemostatic agents have gained wide acceptance in various surgical endeavors. However, the effect of thrombin-based fibrin sealant (fibrin glue) when applied to microvascular anastomoses has not been evaluated thoroughly. Although fibrin sealant has been used directly on vascular anastomoses in macrovascular surgery, there has been little exploration into the utility and potential complications when used in the microsurgical setting. This study explored the influence of fibrin sealant containing increasing concentrations of bovine thrombin on microvascular anastomoses in a rat epigastric free flap model. The survival of the free flap in this model appeared to be inversely proportional to the concentration of thrombin in the fibrin sealant. When thrombin alone was applied to the anastomoses, the rate of thrombosis was the highest. Venous anastomosis was the most sensitive to the deleterious effects of topically applied thrombin.
局部应用的生物黏附剂和止血剂在各种外科手术中已得到广泛认可。然而，基于凝血酶的纤维蛋白密封剂（纤维蛋白胶）应用于微血管吻合术时的效果尚未得到充分评估。尽管纤维蛋白密封剂已直接用于大血管手术中的血管吻合，但在显微手术环境中使用时，其效用和潜在并发症几乎未被探索。本研究在大鼠腹壁游离皮瓣模型中探讨了含不同浓度牛凝血酶的纤维蛋白密封剂对微血管吻合术的影响。该模型中游离皮瓣的存活似乎与纤维蛋白密封剂中凝血酶的浓度成反比。当单独将凝血酶应用于吻合口时，血栓形成率最高。静脉吻合对局部应用凝血酶的有害影响最为敏感。
