Additional Benefit of Heparin in the Thrombolytic Salvage of Ischemic Skin Flaps

Mb, Hirigoyen; Zhang, W; G, Re; Prabhat, Arvind; Ml, Urken; Weinberg, Hubert

doi:10.1097/00000637-199512000-00010

Cited by 22 publications

(9 citation statements)

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“…Platelets adhere to the subendothelial matrix mediated by collagen, fibronectin and Von Willebrand factor. [17][18][19][20] Activated platelets degranulate, releasing ADP and serotonine, which induce the adhesion of other platelets. Thrombin is released, leading to the conversion of fibrinogen into thrombus.…”

Section: Discussionmentioning

confidence: 99%

Estudo da ação da estreptoquinase e do alopurinol em retalhos cutâneos em ilha submetidos à isquemia prolongada: estudo experimental em ratos

Moura¹,

Marques²,

Bernal³

et al. 2009

Rev. Assoc. Med. Bras.

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Objective. To establish a relation between the survival rate for island skin flaps submitted to prolonged ischemia and the effect of streptokinase and allopurinol administered following the prolonged ischemic period. MethOds. A total of 48 male Wistar rats, each weighing between 300 and 350 grams, were separated into four groups of twelve as follows: control, allopurinol, streptokinase, and association of allopurinol and streptokinase. The rats were submitted to epigastric island flap dissection, followed by epigastric vessel bundle clamping. Flaps remained in this condition for 8 hours, in normothermic global ischemia. After the ischemic period, the clamps were removed and each rat received the proposed therapeutic scheme for the group by intravenous injections. Flap survival analysis was performed on the seventh postoperative day. Variance and descriptive analyses (as percentage of necrotic area) were carried out, as well as Dunnett's T3 multiple comparisons among the four groups and the median test. Results. Rats in the control group presented an average necrosis of 79.88% in the total flap area; those receiving allopurinol presented an average necrosis of 64.05%, whereas the group receiving streptokinase presented an average necrosis of 55.52%. With the association of both drugs, rats presented an average necrosis of 54.30% in the total flap area. By applying the Dunnett's test and the median test, we were able to verify that, in this study, the streptokinase group had the lowest rate of necrosis. cOnclusiOn. Compared to the administration of allopurinol, association of allopurinol and streptokinase, and the control group, systemic administration of streptokinase after 8 hours of normothermic global ischemia resulted in an increased survival rate for epigastric island skin flaps in rats.

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Section: Discussionmentioning

confidence: 99%

Estudo da ação da estreptoquinase e do alopurinol em retalhos cutâneos em ilha submetidos à isquemia prolongada: estudo experimental em ratos

Moura¹,

Marques²,

Bernal³

et al. 2009

Rev. Assoc. Med. Bras.

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“…The addition of heparin to urokinase and prostaglandin E 1 improves the efficacy of thrombolysis and vasodilation by preventing both the formation and the incorporation of new fibrin into the thrombus. Hirigoyen et al [21] noted thrombus formation in venules after ischemia-reperfusion injury and described the washout by urokinase and general administration of heparin to be effective against thrombus formation in the microcirculation. However, it is possible that heparin increases the risk of bleeding tendency.…”

Section: Discussionmentioning

confidence: 99%

Tonometer pH<sub>i</sub> Monitoring of Free Jejunal Grafts following Pharyngolaryngoesophagectomy for Hypopharyngeal or Cervical Esophageal Cancer

Kamiya

Suzuki²,

Mineta³

et al. 2007

Dig Surg

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Background/Aims: Graft failure is a critical complication associated with vascular occlusion in esophageal reconstruction with a free jejunal graft following pharyngolaryngoesophagectomy. In this study, we evaluated the usefulness of intramucosal pH (pH_i) measurement using a tonometer to assess the graft viability. Methods: Two consecutive studies, the early phase study and the late phase study, were performed. Nineteen patients who underwent free jejunal transfer were enrolled in the early phase study before 1999 to determine the critical pH_i value. In the late phase study after 2000 (n = 16), anticoagulant treatment to prevent graft necrosis was performed in the patients having a pH_i value under the critical level. Results: In the early phase study, vascular obstruction was not seen in 16 patients with pH_i >7.10. Of 3 patients with pH_i <7.10, 2 underwent regrafting because of jejunal graft necrosis by vascular obstruction. In the late phase study, reoperation was not required in 3 of 4 patients with pH_i <7.10. Intraoperative vascular occlusion was found in 1 patient with a decline in pH_i value and anticoagulant treatment was effective in 2 others. Conclusion: The pH_i measurement using a tonometer is useful for finding vascular problems in free jejunal grafts.

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“…1,4-6 Systemic use of heparin is not routinely used in free tissue transfer due to the risk of systemic bleeding, but is used when a flap is salvaged due to pedicle thrombosis. 17 Topical heparin irrigating solutions are nearly univer-sally employed as heparinized saline or lactated ringers. Several studies have demonstrated efficacy in reducing thrombosis at the anastomosis.…”

Section: Prophylactic Measuresmentioning

confidence: 99%

The pathogenesis of vascular thrombosis and its impact in microvascular surgery

Esclamado

Carroll

1999

Head Neck

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Additional Benefit of Heparin in the Thrombolytic Salvage of Ischemic Skin Flaps

Cited by 22 publications

References 0 publications

Estudo da ação da estreptoquinase e do alopurinol em retalhos cutâneos em ilha submetidos à isquemia prolongada: estudo experimental em ratos

Estudo da ação da estreptoquinase e do alopurinol em retalhos cutâneos em ilha submetidos à isquemia prolongada: estudo experimental em ratos

Tonometer pH<sub>i</sub> Monitoring of Free Jejunal Grafts following Pharyngolaryngoesophagectomy for Hypopharyngeal or Cervical Esophageal Cancer

The pathogenesis of vascular thrombosis and its impact in microvascular surgery

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