Investigation on the Microcirculation Effect of Local Application of Natural Hirudin on Porcine Random Skin Flap Venous Congestion

Abstract

Medicinal leech therapy is commonly used to treat venous congestion by local application to skin flaps, which are frequently employed in re-construction surgery. In the present study, we investigated the effect of natural hirudin, which was applied locally to treat the venous congestion, in random skin flaps in a Guangxi Bama miniature pig model. The congestive random skin flaps were divided into 3 groups: Group A (control group that was locally applied with saline), Group B (locally applied with 20ATU natural hirudin per each flap), Group C (locally applied with 40ATU natural hirudin per each flap). The microcirculatory changes were observed by measuring myeloperoxidase (MPO), malondialdehyde (MDA) and superoxide dismutase (SOD). The level of MPO, MDA and SOD activities in the tissue in hirudin-treated groups was significantly different compared with control group (P < 0.05), but there was no significant difference between group B and group C. At 12 days, as compared to the control group, flap survival rate in hirudin-treated groups was significantly different (P < 0.05), but there was no significant difference between the groups receiving two different doses of hirudin. Natural hirudin can improve microcirculation by inhibiting oxygen free radical damage and also improve flap survival time.

Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps

“…Ying‐Xin et al reported increased survival in compromised free flaps in rats after subdermal injections of both natural or recombinant hirudin compared to controls injected with saline (Ying‐Xin et al, ). Similarly, increased survival of surface area of compromised random pattern skin flaps after local subdermal injection of natural hirudin compared to controls have been reported in the porcine models (Guo‐Qian et al, ; Zhao et al, ). Furthermore, intravenous injection of recombinant hirudin in regional flaps in rabbits has been reported to increase surface area survival compared with injection of low molecular weight heparin or no injection (Duzgun et al, ).…”

“…Previous work reports the use of recombinant or natural hirudin in the treatment of venous congestion in animal models (Duzgun et al, ; Guo‐Qian et al, ; Ying‐Xin et al, ; Zhao et al, ). Ying‐Xin et al reported increased survival in compromised free flaps in rats after subdermal injections of both natural or recombinant hirudin compared to controls injected with saline (Ying‐Xin et al, ).…”

“…Bivalirudin is a direct inhibitor of thrombin (which activates both platelets and other clotting factors), thereby leading to an inhibition of the clotting cascade (Di Nisio et al, 2005). Additionally, local injection of natural or recombinant hirudin directly into congested flaps have revealed evidence of improved flap survival in rat (Ying-Xin, Guo-Qian, Jia-Quan, & Han, 2012), rabbit (Duzgun, Nisanci, & Unlu, 2014), and pig models (Guo-Qian, Gang, & Zhi-Yong, 2012;Zhao, Shi, Sun, Yin, & Yang, 2012). The extent to which recombinant hirudin, such as bivalirudin, may aid in relief of venous congestion in head and neck reconstructive flaps in patients has not previously been studied.…”

“…Previous work reports the use of recombinant or natural hirudin in the treatment of venous congestion in animal models (Duzgun et al, 2014;Guo-Qian et al, 2012;Ying-Xin et al, 2012;Zhao et al, 2012). Zhao et al, 2012).…”

Application of Normobaric Hyperoxygenation to an Ischemic Flap and a Composite Skin Graft

“…18,19,20 The oxygen content in a fluid (blood) of one deciliter [ C (O 2 )] is expressed by the following equation 19,20 :…”