Development of blood vessels of the greater omentum in the hepatic lobe after vascular ligation: an experimental model in the rats

Silva, Paulo César; Jamel, Nelson; Refinetti, Ricardo Antonio; Manso, Eduardo Ferreira; Schanaider, Alberto

doi:10.1590/s0102-86502006000600011

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…A capacidade angiogênica do omento maior foi também demonstrada em transplante hepático humano que apresentou vascularização espontâ-nea nas aderências teciduais 39 . Conforme relatamos, freqüentemente observamos o omento aderente ao pólo inferior e, nesses locais, vasos sangüíneos.…”

Section: Discussionunclassified

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

Paulo¹,

Paulo²,

Ferrari³

et al. 2008

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVO. Estudar aspectos funcionais e morfológicos do pólo inferior do baço de ratos tratados ou não com oxigênio hiperbárico no pós-operatório. MÉTODOS. Foram operados 79 ratos, Wistar, pesando 248,7g ± 27 , distribuídos em dois grupos: A -Simulação (n= 40), B -pólo inferior (n=39), e divididos em dois subgrupos: 11 e 70 dias. Cada subgrupo foi subdividido em não tratado com oxigênio hiperbárico (nt) (A11nt-n=10, B11 nt-n= 13, A70nt-n= 10, B70nt-n= 9) e tratado (t); A11t-n=10, B11t-n=9, A70 t-n= 10, B70t-n= 8). Foram dosados os lípides e imunoglobulinas e contadas as plaquetas e os corpúsculos de HowellJolly no pré e no pós-operatório. O baço e o pólo inferior foram retirados para histologia. RESULTADOS. Houve aumento do colesterol total (p=0,002), VLDL-colesterol e triglicérides (p= 0,003), da 013) INTRODUÇÃOA esplenectomia total pode provocar complicações no transoperatório e no pós-operatório 1 . Dessas, a mais preocupante é a infecção fulminante que foi relatada por King e Schumaker Jr 2 e foi recentemente revista 3 . As complicações infecciosas, após a retirada do baço, foram também observadas em animais de experimentação 4,5 . As alterações no metabolismo lipídico têm sido relatadas após esplenectomia total tanto em seres humanos 6 quanto em animais de experimentação 7-11 e podem causar aterosclerose 7 . Por essas razões têm sido valorizadas as operações conservadoras sobre o baço que compreendem as oclusões vasculares [12][13][14][15][16] , esplenorrafias 17 , esplenectomias parciais 18-20 e os auto-implantes 21,22 . Dessas, a mais recentemente descrita, em cães, foi a esplenectomia subtotal com preservação do pólo inferior, mesmo com a ligadura dos vasos esplênicos principais 23 . Nessa operação, observou-se aumento significante do colesterol e da fração LDL no pós-operatório mediato, e sugeriu-se a possibilidade de isquemia do pólo inferior remanescente. Por esse motivo, seria interessante utilizar um método para combater a isquemia e, possivelmente, melhorar a função do pólo inferior, no pós-operatório mediato.A oxigenoterapia hiperbárica (OHB) é um método terapêutico no qual o indivíduo é submetido à inalação intermitente de oxigênio (O 2 ) a 100%, a uma pressão maior que a atmosférica, no interior de uma câmara hiperbárica 24 . Essa modalidade terapêutica tem sido utilizada no tratamento de várias doenças. No Brasil, a Resolução CFM 1457/95 do Conselho Federal de Medicina regulamentou seu uso nas seguintes indicações: embolia gasosa, embolia traumática pelo ar, envenenamento por monóxido de carbono, gangrena gasosa clostridiana, doença de Fournier, isquemias agudas traumáticas, queimaduras térmicas ou elé-tricas, lesões por irradiação, osteomielite, retalhos ou enxertos comprometidos ou de risco. No nível experimental demonstrou-se que a OHB tem efeito angiogênico 25,26 , estimula a formação de circulação colateral 27 , aumenta o conteúdo arterial de oxigênio e a elasticidade dos glóbulos vermelhos 28 , acelera a cicatrização do baço após a ligadura simultânea da artéria e veia esplênicas...

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Section: Discussionunclassified

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

Paulo¹,

Paulo²,

Ferrari³

et al. 2008

Rev. Assoc. Med. Bras.

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“…14 The angiogenic capacity of the greater omentum has been demonstrated when the hepatic artery is connected during liver transplantation, followed by implantation of the greater omentum, 15 or when fixed to the hepatic parenchyma after suppression of hepatic blood flow. 16 Growth of the remaining lower splenic pole may thus be explained by the presence of blood vessels potentially capable of promoting this effect. Further investigations will be necessary to determine the role of angiogenesis using molecular biology methods and spleen stem cells in order to identify and understand the expression of proteins possibly involved in spleen growth.…”

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confidence: 99%

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

et al. 2008

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PURPOSE: To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels. METHODS: Thirty-nine Wistar rats (328.8 ± 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed. RESULTS: In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2. CONCLUSION: The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

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“…This role is fostered by certain features of the greater omentum, such as large surface as well as excellent arterio-venous vascularization and lymphatics supply, greater omentum anatomically and physiologically is designed to survive in a purulent environment which stems from, as was demonstrated by Goldsmith and Browne, from the fact that it produces active lipid substances of angiogenetic, osteogenetic as well as immunostimulant properties. (4,6,(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by good adhesiveness to injured tissue, potential for neogenesis and neo-osteogenesis. Revascularization of base allows for transport of antibiotic inside the focus of infection (4,5,6). Ion Kiricuta, a Romanian surgeon-oncologist, should be considered the author of this method, who in the 1960s applied pedicled greater omentum flaps in the treatment of vaginal fistulas, thoracic post-radiation injuries, and in later years (demonstrating the 505 Management of extensive or infected soft tissue defects in upper limb by means of pediculated omental flaps capability of freely flap elongation) as well as in the treatment of lyphatic edema (6,7).…”

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confidence: 99%

Management of Extensive or Infected Soft Tissue Defects in Upper Limb by Means of Pediculated Omental Flaps

Domanasiewicz¹,

Kaczmarzyk²,

Paruzel³

et al. 2009

Polish Journal of Surgery

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The basis for the treatment of deep tissue defects, particularly those that are infected, is coverage of the exposed anatomical structures with well vascularized tissues. To this end various kinds of vascularized-pedicled and free flaps are utilized. Post-trauma, soft tissue defects in the region of the upper extremity often involve areas of tissue poorly perfused, affected by necrosis and bacterial colonization. The size of the defect with accompanying intense purulence limits the application of local reconstruction and fasciocutaneal and muscle flaps. The greater omentum is one of the most promising and universal flaps on account of it's bactericidal and angiogenetic properties. The first report regarding a successful application of omentum in plastic surgery dates from 1965 year. the aim of the study was to present treatment results of extensive as well as infected tissue defects of upper limb with the application of pedicled omental flaps in material from Sub-Department of Limb Replantation in Trzebnica. Material and methods. Between 2005Between -2009 in the St. Hedwig's Hospital 35 patients (30 M, 5 F) avg age 38.3 (range 10-73) were treated using omentum flaps. The causes of defects were primarily crush injuries (13), burn wounds (2), secondary necrosis of replanted/revascularized limb tissues (14) including chronic bone infections, contaminated degloving injuries of upper limb (4). The area of tissue defect amounted to avg 84 cm 2 (range 25-227 cm 2 ) Most of this, 31/35 (89%) posed infected wounds (Staphylococcus aureus 11, Escherichia coli 12, Enterococcus faecalis 11, Staphylococcus coagulsonegative 10, Pseudomonas aeruginosa 5, Acinetobacter baumanii 6, Proteus mirabilis 6, Enterobacter cloacae 4). The procedure was based on covering of the defects with pedicled omental flap obtained during epigastric laparotomy, with split-thikness skin graft. After the procedure apart from the surgical prophylaxis general antiobtic therapy was not applied, nor locally. After 3-4 weeks the pedicle of flap was cuted and it's appearance was modeled as well as covered using skin graft. Results. Complete healing with good fuctional and cosmetic results was achieved in 32/35 cases, after transplantation of omentum in 52% of wounds a change in bacterial flora was observed to saprofitic and antibiotic-sensitive, and in 38% donor site was aseptic. Cultures were attained, in the remainder signs of infection receded despite the presence of pathological flora. In 2 cases complete or partial necrosis of flap was observed, in one the vital flap was removed due to amputation of limb (crush syndrome). Complication in the form of hernia were observed in 5/35 patients, however no complaints of abdominal pain or abscess of space drawing. Conclusions. Free and pedicled omental flaps appear to be the ideal solution in the treatment of tissue defects and bone infections chronically infected with antibiotic-resistant cultures. The omentum also is a appropriate material for covering of fresh defects with exposed ligaments, nerves and bone...

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Development of blood vessels of the greater omentum in the hepatic lobe after vascular ligation: an experimental model in the rats

Cited by 4 publications

References 11 publications

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

Management of Extensive or Infected Soft Tissue Defects in Upper Limb by Means of Pediculated Omental Flaps

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