Salvage of Free Flaps After Secondary Venous Ischemia by Local Delivery of Heparin

Kirschner, Richard E.; Xu, Jun; Fyfe, Billie; Chang, Benjamin; Bucky, Louis P.

doi:10.1097/00000637-199905000-00010

Cited by 14 publications

(23 citation statements)

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“…The principal treatment of venous occlusion involves exploring an anastomosis site of the vessel and then eliminating the cause of the occlusion, such as intravascular thrombosis or vessel kinking. Treatments with medical leech or heparin have also been used and shown good results. However, these treatments simply offer an outlet for the congested blood flow and do not prevent further tissue damage caused by reperfusion.…”

mentioning

confidence: 99%

Improved skin flap survival in venous ischemia‐reperfusion injury with the use of adipose‐derived stem cells

et al. 2015

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mentioning

confidence: 99%

Improved skin flap survival in venous ischemia‐reperfusion injury with the use of adipose‐derived stem cells

et al. 2015

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“…who found no effect of heparin anticoagulation in a porcine latissimus dorsi model of distal ischaemia (5). In contrast, other investigators have shown that heparin prevents IR injury and increases flap survival in a rat model (19), which indicates that species differences may be of critical importance. Pigs tnay be particularly resistant to anticoagulation or to inhibition of TF-mediated events in genera!…”

Section: Discussionmentioning

confidence: 96%

Effect of active site‐inactivated factor viia on ischaemia/reperfusion injury in a porcine flap model

Söderström

Birk-Sørensen²,

Holst-Jensen³

et al. 2004

Scandinavian Journal of Plastic and Reconstructive Surgery and

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In free flap surgery, restored blood flow following a lengthy ischaemic period may lead to necrosis as a result of ischaemia/reperfusion (IR) injury. This injury comprises both proinflammatory and prothrombotic events, where the tissue factor/factor VIIa complex probably has a key role. Active site-inactivated factor VIIa (FFR-rFVIIa) exerts an antithrombotic effect by binding to tissue factor without initiating coagulation. In this study we have evaluated the potential protective effects of FFR-rFVIIa in IR injury. Bilateral musculocutaneous latissimus dorsi flaps in 16 pigs were made ischaemic for eight hours, then given 1 mg/kg/flap of FFR-rFVIIa or vehicle intra-arterially, and reperfused for 10 hours. The viable:necrotic tissue ratio, and accumulation of radiolabelled leucocytes, fibrinogen, and platelets were measured. There was no effect on tissue survival, but radiolabelled components in viable tissue were increased, though not significantly so. We conclude that FFR-rFVIIa did not prevent IR injury, indicating that tissue factor-mediated coagulation is not an important determinant of IR injury in this setting.

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“…Former experiments with neurovascular epigastric skin island flaps in the rat model demonstrate that systemic treatment with 300 I.U./kg of heparin increases the tissue tolerance to venous occlusion and significantly improves flap survival [29]. Also, heparin proved effective in free musculocutaneous flap salvage following secondary venous stasis even in low dose application (5-6 IU/kg) when administered into the flap artery [14]. Consequently, the dosage of heparin in this study with intraarterial administration was determined to be optimal at 100 I.U./kg.…”

Section: Discussionmentioning

confidence: 99%

“…Local and systemic application of heparin for preventive and therapeutic purposes is therefore an approved procedure in free flap surgery. It is also known that the local delivery of low dose heparin increases the survival rate of free flaps after secondary venous ischemia [14]. In addition, the fibrinolytic substance, recombinant tissue plasminogen activator (rtPA), has a place in the repertoire Table 1 Experimental design…”

Section: Introductionmentioning

confidence: 99%

Examination of the protective effects of heparin and recombinant tissue plasminogen activator (rtPA) in compromised adipocutaneous free flaps in the rat model using intravital video microscopy

Wallmichrath

Birk

Baumeister

et al. 2015

Clinical Hemorheology and Microcirculation

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BACKGROUND:The purpose of this study was to determine whether the focused delivery of heparin or recombinant tissue plasminogen activator (rtPA) by rinsing accords protective effects which increases the survival of free groin flaps following fatal secondary venous stasis. METHODS: Free microvascular groin flaps (n = 40) were transplanted to the necks of adult Sprague-Dawley rats 20 hours before the experiment. The study groups (each n = 10 animals) were: No adjunctive treatment (Group I), Ringer's solution (Group II), heparin solution (100 IU/kg, group III) and rtPA (2 mg/kg, group IV), respectively. The flap vein was then clamped for 35 minutes. Intravital video microscopy was applied and flap viability was assessed 14 days later. RESULTS: Mean flap necrosis was 90% in group I and II, whereas the rate of flap survival was 80% in group III and 60% in group IV, respectively. CONCLUSIONS: Even though clinical and microvascular flap perfusion parameters in both the rtPA-group and heparin group were initially similar, it has been demonstrated here in our investigations that the flaps treated with heparin showed a higher viability rate. Therefore, we can conclude that the focused delivery of heparin and rtPA resulted in a significantly improved flap salvage.

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Salvage of Free Flaps After Secondary Venous Ischemia by Local Delivery of Heparin

Cited by 14 publications

References 0 publications

Improved skin flap survival in venous ischemia‐reperfusion injury with the use of adipose‐derived stem cells

Improved skin flap survival in venous ischemia‐reperfusion injury with the use of adipose‐derived stem cells

Effect of active site‐inactivated factor viia on ischaemia/reperfusion injury in a porcine flap model

Examination of the protective effects of heparin and recombinant tissue plasminogen activator (rtPA) in compromised adipocutaneous free flaps in the rat model using intravital video microscopy

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