impact of different antithrombotics on the microcirculation and viability of perforator-based ischaemic skin flaps in a small animal model - digital graphic tablet

The effect of anti-thrombosis drugs on the survival of random and free flap has been studied in the past, but the experimental and clinical results are inconsistent. A perforator-
The critical ischemia model was used to evaluate the effects of drugs administered during different perioperative periods on tissue ischemia and to evaluate the potential additional blood degeneration or vascular expansion effects of anti-thrombosis drugs on flap blood circulation.
Combined laser Doppler blood flow measurements and mitigation spectra showed an increase in certain blood flow parameters in most groups compared to saline controls, and these changes were associated with flap survival.
Aspirin and hirudin significantly improved the number of surviving flap tissues compared to the control group, while inactive heparin had a negative effect on flap survival.
Low-molecular-weight heparin, aspirin, pentoxiromine and β-starch had no effect on the amount of tissue of the surviving flap.
A higher rate of complications was observed in all experimental groups, but only clavig had a negative effect on flap survival.
Our results provide substantial evidence to support the conclusion that anti-thrombosis therapy improves flap survival during the perioperative period.
Clopidogrel and hirudin are effective drugs that significantly increase the vitality of the cells passing through the branches
But the risk of postoperative bleeding is high.
All animals are treated and raised in accordance with EU guidelines.
The study was approved by the regional government (
Government von Oberbayern, AZ55. 2-1-54-2532-129-10)
It was carried out under the German animal welfare law.
A total of 108 male Wistar rats (280–320u2009g, Fa.
River Charles, Clegg, Germany)were used.
Food and water were provided.
All operations were performed under general intravenous anesthesia.
100 mg/kg ketamine (Narketan®, Fa.
Vetoquino Co. , Ltd. , Ravensburg, Germany)
And 5 mg/kg cerazin (Rompun®, Fa.
Bayer life, Germany)]
And the aseptic conditions described elsewhere, and do everything possible to minimize the pain.
As described in detail elsewhere, the upper abdomen flap is proposed as a penetrating flap, based on a single primary penetrating branch from the lower abdomen deep system, with a standardized size of 4 × 7 × cm).
An oversized flap model was selected to detect the possible effects of different agents on the viability of the critical perfusion area of the flap.
After the flap is raised, it is stitched back to the wound bed with a 6-0 single wire intermittent stitching (
Germany Norderstedt essekong).
All the mice were random by computers.
Generate a list and divide it into nine groups (nu2009=u200912).
After strict protocol, ASA, clopidogrel, unreactive heparin, low molecular weight heparin (clexane), hirudin (lepirudin)
, Has been applied to cocoa or HES (nu2009=u200912 each)
Started before surgery and lasted seven days.
Normal Saline was used in each group during the perioperative period (control group)
Or effective drug treatment according to the drug treatment plan described in.
The dose and frequency used in this study were selected according to the recommendation in the literature, or, if there is no similar animal study, specified according to the human dose recommendation.
Measurement of tissue oxygen saturation in addition to observing flap color and capillary filling (SO2 in %)
Hemoglobin levels (
Hb, AU in any unit), blood flow (in AU)and velocity (in AU)were non-
Measurement and mitigation spectra using combined laser Doppler flow (
O2C with LF-
Month probe, Lea Medizintechnik, Giessen, Germany).
This technique is an established procedure for evaluating free flap, which has been described in detail elsewhere.
O2C was performed before all operation groups (base value)
, After the flaps rise, in 7 days.
All measurements were taken from the central part of the flap and, if possible, compared to the same area.
If necrosis occurs, measurements are taken from the central area of the remaining surviving flap tissue.
After 7 days of operation, the rats were anesthesia again and the flap healing was recorded using a digital SLR camera (
Nikon Coolpix model 8700. Nikon Corp.
Chiyoda, Tokyo, Japan)
Mounted vertically on the flap with a tripod.
Images of important and necrosis areas were analyzed.
Therefore, with the help of the graphic tablet, the total area of the flap and the area of necrosis are manually restricted and crossed
Calculate the section area using the image j software program.
Use a fatal pentobarbital injection under deep anesthesia (
200 mg/kg, nakron, Rhone-
Rafim merrier, Germany)
Bleeding by cutting off the abdominal aorta.
As mentioned above, the flap was lifted and all signs of tumor or serum tumor were recorded and scored according to the severity of the complication (“−”u2009=none, “(+)
"Moderate = very small," "u2009 = small," "u2009 = medium," "u2009 = serious).
For basic statistical analysis, Prism Software (
Prism 7, 7 version of Mac OS X.
GraphPad Software Co. , Ltd. 0a
La Jolla, California, United States of America)was used.
SPSS software package (
SPSS 22 by SPSS
Chicago, USA)
For multi-variable analysis.
Evaluation of necrosis rate by common method
Variance analysis was used to determine the significance of the differences between groups.
The multi-Comparison test of Tukey is used to explain the problem of multiple tests.
Pearson's correlation was used to determine whether Postoperative hematoma formation had a significant impact on flap survival.
The difference between the two was considered statistically significant.
Edge Value of