The Effect of Hypothermia and Tissue Perfusion on Extended Myocutaneous Flap Viability

Tsai, Tsu‐Min; Jupiter, Jesse B.; Serratoni, Frank T.; Seki, Toshiaki; Okubo, Kazuaki

doi:10.1097/00006534-198210000-00006

Cited by 35 publications

(20 citation statements)

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“…30 It is well known that hypothermia prolongs the critical ischemia time of muscle and musculocutaneous flaps. 9,[31][32][33][34][35] However, the present study showed no protective effect of hypothermic ischemia on inflammatory cytokine secretion following ischemiareperfusion injury compared with normothermic ischemia. Hypothermic ischemia reduces flap ischemic tissue damage by lowering the metabolic rate, 11 but no parameters could elucidate this antiischemic effect of hypothermia in the present study.…”

Section: Discussioncontrasting

confidence: 79%

Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia‐reperfusion injury

et al. 2016

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Section: Discussioncontrasting

confidence: 79%

Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia‐reperfusion injury

et al. 2016

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“…Several investigators studied continuous perfusion with various media, such as heparinised saline [8,15], Ringer solution [22], oxygenated fluorocarbon [28,31], plasma [25,26], Collins solution [15,17,29] or Ross solution [14]. Several investigators studied continuous perfusion with various media, such as heparinised saline [8,15], Ringer solution [22], oxygenated fluorocarbon [28,31], plasma [25,26], Collins solution [15,17,29] or Ross solution [14].…”

Section: Discussionmentioning

confidence: 99%

Successful long-term storage of rat limbs

Arai

Hotokebuchi

Miyahara

et al. 1993

International Orthopaedics

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The effect of simple cold storage in Euro-Collins solution on prolonging successful preservation time was examined on an established rat limb transplant model. Limbs amputated at mid-thigh level were simply immersed in the solution and stored in a refrigerator at 4 ° C. After varying periods of cold storage, the limb was orthotopically grafted to another isogeneic rat using microsurgical techniques. The survival rates for 12, 24, 48 and 72 hours' storage were 100%, 90%, 67% and 50% respectively, and the longest time of successful preservation achieved was 78 hours. Survival rates were greatly decreased when amputated limbs were initially perfused with Euro-Collins solution and immersed in the same solution. In a third set of experiments, the limbs were preserved by a conventional method of cold storage in air, and the survival rates were decreased even further. Evaluation by measuring postoperative paw swelling and microscopic examination of the grafts further confirmed the effectiveness of the simple immersion method without perfusion. R6sum6. Nous avons dtudi~, sur la patte de rat, choisie comme modble de transplant, l'effet du simple stockage au froid dans la solution Euro-Collins sur la prolongation du temps de conservation. Les pattes, amputees it mi-cuisse, ont dt~ simplement plong~es dans la solution, puis conservdes dans un rdfrigdrateur it la tempdrature de 4°C. Apr~s des durdes variables de stockage au froid les pattes ont dtd greffdes sur d'autres rats isog~niques, de fafon de survie des transplants aprbs 12, 24, 48 et 72 heures de conservation fut respectivement de 100%, 90%, 67% et 50%, et la plus longue dur(e de conservation efficace fut de 78 heures. Les taux de survie ont diminud de fafon importante lorsque les transplants Ctaient d'abord perfusds avec la solution Euro-Collins puis immergds dans cette m6me solution. Dans un troisi~me groupe d'expdriences, les pattes amputees furent conservdes de fafon traditionnelle par stockage au froid it l'air, et les taux de survie des greffes diminu~rent encore plus. L'dvaluation par la mesure du gonflement de la patte greffde ainsi que l' examen microscopique ont confirmd l'efficacit~ de la simple immersion sans petfusion.

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“…34,40 It can extend the viability of musculocutaneous flaps for up to 96 hours; however, intraarterial flushing with ice-cold modified Collins solution can further extend this time. 41 In 1992, Francel et al reported a 100 percent success rate when using such a technique during the closure of 80 patients with grade III open tibia-fibula fractures using free muscle transfers. However, this treatment is only applicable for muscle flaps and not other types of flaps with skin components, such as myocutaneous, fasciocutaneous, or perforator flaps.…”

Section: Hypothermia and Intraarterial Flushingmentioning

confidence: 99%

Reperfusion Injury

Khalil¹,

Aziz²,

Hall³

2006

Plastic and Reconstructive Surgery

133

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The restoration of blood flow to ischemic tissues causes additional damage, which is termed reperfusion injury. All tissues are susceptible to reperfusion injury, but this susceptibility varies between tissues. Reperfusion has wide clinical relevance. It influences the outcome of patients after myocardial infarction, stroke, organ transplantation, and cardiovascular surgery. Advances in the treatment of reperfusion injury have created an opportunity for plastic surgeons to apply these treatments to flaps and reimplanted tissues. The main putative mechanisms identified in animal models involve leukocyte-endothelium interactions, reactive oxygen species, and the complement system. However, it has become evident that these fundamental biological systems are controlled by many interrelated pathways. Attempts to bypass this complexity have led to a search for the early "upstream" initiating events, rather than the "downstream" cascading events. This contrasts with current clinical efforts that are directed toward hypothermia, intraarterial flushing, and preconditioning. This article outlines the molecular and cellular events that occur during reperfusion injury and then reviews the efforts that have been made to exploit this knowledge for clinical advantage.

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The Effect of Hypothermia and Tissue Perfusion on Extended Myocutaneous Flap Viability

Cited by 35 publications

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Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia‐reperfusion injury

Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia‐reperfusion injury

Successful long-term storage of rat limbs

Reperfusion Injury

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