Browse > Article

EFFECT OF ARTERIAL REPAIR AND PATENCY AFTER MICROVASCULAR ANASTOMOSIS WITH TOPICAL IRRIGATION OF VARIOUS ANTI-THROMBUS DRUGS  

Choi, Yong-Chul (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University)
Kim, Kyung-Wook (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University)
Kim, Chul-Hwan (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University)
Publication Information
Journal of the Korean Association of Oral and Maxillofacial Surgeons / v.32, no.2, 2006 , pp. 117-128 More about this Journal
Abstract
Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after micro-arterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.
Keywords
Microvascular Anastomosis; Anti-thrombus drug; Heparin; Urokinase;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Fernandez EJ, Nadal RD, Gonzalez SM, Caffee HH: The effect of stasis on a microvascular anastomosis. Microsurgery 1983;4:176-177   DOI
2 Bertele V, et al: Platelet thromboxane synthetase inhibitors with low doses of aspirin: possible resolution of the 'aspirin delemma.' Science 1983;220:517   DOI
3 Scinclair S: The importance of topical heparin in microvascular anastomosis: a study in the rat. Br J Plast Surg 1980;33:422-426   DOI   ScienceOn
4 Mahadoo J, Hiebert LM, Jaques LB: Vascular sequestration of heparin. Thromb Res 1977;12:79-90   DOI   ScienceOn
5 Rogenberg RD: Action and interaction of antithrombin and heparin. N Engl J Med 1975;292:146-156   DOI   ScienceOn
6 Johnson PC, Barker JH: Thrombosis and antithrombotic therapy in microvascular surgery. Clin Plast Surg 1980;33:422-426   DOI   ScienceOn
7 Thurston JB, Buncke HJ, Chate NL Weinstein PR: A scanning electron microscopy of microarterial damage and repair. Plast Reconstr Surg 1976;57:197   DOI   ScienceOn
8 Milward T, Rayner CRW: A method for studying endothelial regeneration in small vessels. Plast Reconstr Surg 1979;63:245   DOI   ScienceOn
9 Chisolm G, Gainer J. Stoner G: SEM(scanning electron microscope) studies of aortic structure. Angiologica 1973;10:10
10 Webster W, Bishop S, Geer J: Experimental aortic intimal thickening. Am J Path 1974;76:265
11 Acland R: Thrombus formation in microvascular surgery:An experimental study of effect of surgical trauma. Surg 1973;73:766-771
12 Khouri RK, Cooley BC, Kenna DM, Edstrom LE: Thrombosis of microvascular anastomosis in traumatized vessels: fibrin versus platelets. Plast Reconstr Surg 1990;86:110-117   DOI   ScienceOn
13 Shoop R, Bakerzak SP, Larrimer NR, Lee RE: Surface morphology of early hemostatic reaction. Am J M Sci 1970;260:122   DOI   ScienceOn
14 Holmsen H, Day HJ, Stormorken H: The blood platelet release reaction. Scand J Haematol Suppl 1961;8:3-26
15 Colman RW, Hirsch J, Marder VJ, Salzman EW: Hemostasis and thrombosis: Basic principle and clinical practice. 2nd ed. Lippincott, Philadelphia, pp594, 1982
16 Matthew HC, William PA: Pharmacologic optimization of microurgery in the new millenium. Plast Preconstr Surg 2001;108:2088-2096   DOI   ScienceOn
17 Lattel GL: Thrombolytic therapy: A new strategy for the treatment of acute myocardial infarction. N Engl J Med 1994;311:710   DOI   ScienceOn
18 Leser-Zuschrigften: Dosierung un uber wachung der thrombolyse therapie mit urokinase. Dtsch Med Wsch 1980;105:419
19 Kroll SS, et al: Anticoagulants and hematomas in free flap surgery. Plast Reconstr Surg 1995;96(3):643   DOI   ScienceOn
20 Glimelius B, Busch CH: Binding of heparin on the surface of cultured human endothelial cells. Thromb Res 1978;12:773-782   DOI   ScienceOn
21 Sasahue AA: When and how to use fibrinolytic agents. Drug Ther 1984;9:11
22 Ljungstroem KG: Prophylaxis of postoperative thromboembolism with dextran 70: improvement of efficiency and safety. Acta Chir Scand 1983;514:1
23 Halton RB, O?Brien BM, Morrison A et al: Survival factors in replantation and revascularization of the amputated thumb: 10 years experience. Scand J Plast Reconstr Surg 1984;18:163-168   DOI
24 Ham JM, Slack WW: Platelet adhesiveness after operation. Br J Surg 1967;54:385   DOI   ScienceOn
25 Nightingale G. Fogdestam I, O'Brien BM: Scanning electon microscopie study of experimental microvascular anastomosis in the rabbit. Br J Plast Surg 1980;33:283   DOI   ScienceOn
26 Reichel CA, Croll GH, Puckett CL: A comparison of irrigation solution for microanastomosis. J Hand Surg 1988;13A:33-36
27 Heibert LM, Jaques LB: Heparin uptake on endothelium. Artery 1976;2:26-37
28 Stewart G, Ritchie W, Lynch P: Venous endothelial damage produced by massive sticking and emigration of leukocytes. Am J Path 1974;74:507
29 Acland RD: Prevention of thrombosis in microvascular surgery by the use of magnesium sulfate. Br J Plast Surg 1972;25:292   DOI   ScienceOn
30 Swhney CP: The role of heparin in restoring the blood supply in ischemic skin flaps: an experimental study in rabbits. Brit J Plast Surg 1980;33:430   DOI   ScienceOn
31 Srinivasan S, Aaron R, Chopra PS, Lucaset T, Sawyer PN: Effect of thrombotic and antithrombotic drugs on the surface charge characteristics of canine blood vessels: In vivo and in vitro studies. Surgery 1968;64:827-833
32 Mosele HS, Connel RS, Krippaehne WW: Healing of the canine aorta after endartherectomy, A scanning electron microscopy. Ann Surg 1974;180:329   DOI   ScienceOn
33 Pottie R, Rossouw DJ, Zeeman BJ, Lamont A: Experimental reclamping of free-flap pedicles: the effect of prolonged stasis on the anastomosis and clamp site. Plast Reconstr Surg 1987;79:786-795   DOI
34 Hoff H, Gottlob R: Ultrastructural changes of large rabbit blood vessels following mild mechanical trauma. Virchow's Arch Pathol Anat 1968;345:93   DOI
35 Gordon HS: Experimental evidence for involvement of prostaglandins in viability of acute skin flaps: Effects on viability and mode of action. Plast Reconstr Surg 1981;67:355   DOI   ScienceOn
36 Oneal RM, Knode RE, et al: The effect of low molecular weight dextran on the survival of skin flap in pig's vascularized either by a single artery and vein or by a subdermal plexus. Plast Reconstr Syrg 1957;40:496
37 Baker SR: Complications of microvascular surgery. In Bakers SR, editor: Microsurgical Reconstruction of the Head and Neck. New York, 1989, Churchill Livingstone
38 Jacobson JH, Suarez EL: Microsurgery in anastomosis of small vessels. Surg Forum 1960;11:243
39 Adams WP, Ansari MS, Hay MT, et al: Patency of different arterial and venous end-to-side microvascular techniques in a rat model. Plast Reconstr Surg 2000;105:156-161   DOI   ScienceOn
40 Shaw WW, Converse JM: A survey of 2680 free flaps: Survival, donor site and applications among experienced microvascular surgeons. Proceedings of the Fiftieth Annual Convention of the American Society of Plastic and Reconstructive Surgeons. Plast Surg Forum 1981;4:93
41 O, Brien BM, Hayhurst JW: Principle and techniques of microvascular surgery. In Converse LM, ed. Reconstructive Plastic Surgery, 2nd ed., Philadelphia, London.Toronto. Saunders, 1977. pp349
42 Palmer B: sympathetic denervation and innervation of cutaneous blood vessels following surgery. Scand J Plast Reconstr Surg 1970;4:93-99   DOI
43 Zimberg EM, Choo DI, Zotter LA: The effect of heparinized irrigating solution on patency of experimental microvascular anastomosis. Microsurgery 1989;10:103-107   DOI   ScienceOn
44 Harashina T, Fujino T, Watanabe S: The intimal healing of microvascular anastomosis. Plast Reconstr Surg 1976;58:608   DOI   ScienceOn
45 Groniowski J, Biczyskowa W, Walski M: Scanning electron microscope to biologic investigations. Lab Invest 1966;15:1320
46 Acland RD, Lubbers LL, Grafton RB, Bensimon R: Irrigating soltution for small blood vessel surgery-A histologic comparison. Plast Reconstr Surg 1980;65:460-466   DOI   ScienceOn
47 Swartz WM, Banis JC: Head and neck microsurgery, Boltimore, 1992, Williams and Wilkins
48 Weinstein PR, Mehdom M, Szabo Z: Microsurgical anastomosis, Vessel injury, regeneration and repair. Serafin D, Buncke HJ (ed) Mosby St Louis, Toronto, London, 1977 pp111-144
49 Goulian D: The use of bromphenol blue in the assay of rheomacrodes effects on flap viability. Plast Reconstr Surg 1967;39:227   DOI   ScienceOn
50 Clauss A: Gerinnungsphsiologische Schnell methode zur brstimmung des fibrinogens. Acta Haemat 1957;17:237   DOI   ScienceOn
51 Born GVR, Gross MJ: Effects of inorganic ions and plasma proteins on the aggregation of blood platelets by adenosine diphosphate. J Physiology(Lond) 1964;170:397
52 Bjorkerus S, Bondjers G: Arterial repair and atherosclerosis after mechanical injury. Artherosclerosis 1971;13:335
53 O'Reilly RA: Anticoagulant, antithrombotic and thrombolytic drugs. In The Pharmacological basis of therapeutics 7th ed. Macmillan Publishing. Co. New York, 1985
54 Hudson DA, Engelbrecht G, Duminy FJ: Another method to prevent venous thrombosis in microsurgery:An in situ venous catheter. Plast Reconstr Surg 2000;105:999-1003   DOI   ScienceOn
55 Stemerman MB, Spact TH: The subendothelium and thrombogenesis. Bull NY Acad Med 1972;48:289-301
56 Hergrueter CA, Handren J, Kersh R, May JW Jr: Human recombinant tissue type plasminogen activator and its effect on microvascular thrombosis in the rabbit. Plast Reconstructr Surg 1988;81:418-424   DOI   ScienceOn
57 Fuchs JC, Hagen PO: Long-term fate of autologous vein grafts. Microsurgical composite tissue transplantation. Serafin D, Buncke HJ (ed) Mosby St Louis, Toronto, London, 1977 pp90-110
58 Sunage T, Shimammoto T, Nelson E: Correlated scnning and transmission electron microscopy of arteral endothelium. In Scanning Electron Microscopy ed by O Johari, I Corvin. Reserch Inst, Chicago, 1973, pp459
59 Zdebhick TA, Schaffer JW, Field GA: The use of urokinase in ischemic replanted extrimities in rats. J Bone Joint Surg 1987;69A:442
60 Stassen JM: Intraoperative thrombolytic treatment of microarterial occlusion by selective rt-PA Infusion. Plastic and Reconstructive Surgery 1995;96(5):1215   DOI   ScienceOn
61 Jaques LB, Hiebert LM: The close relationship of heparin and the vessel wall. Artery 1989;16:140-150
62 Skulesky E, Rudich Z, Danon D: Surface charge properties of luminal front of blood cells: An electron microscopical analysis. Thumb Res 1975;7:623-628   DOI   ScienceOn
63 Johnson PC, Barker JH: Thrombosis and antithrombotic therapy in microvascular Surgery. Clin Plast Surg 1992;19(4):799
64 Scinclair S: The importance of topical heparin in microvascular anastomosis: a study in the rat. Br J Plast Surg 1980;33:422   DOI   ScienceOn
65 Romano JE, Biel MA: Thrombolysis in microvascular surgery using tissue-type plasminogen activator. Arch Otolaryngol Head Neck Surg 1989;115:1318-1321   DOI   ScienceOn
66 Artruson G, Khanna NN: The effects of hyperbaric oxygen, dimethyl surfoxide and complamin on the survival of experimental skin flaps. Scand J Plast Reconstr Surg 1970;4:80