Microvascular Fibrinolysis after Ischemia: Its Relation to Vascular Patency and Tissue Survival

Jacobs, Gary R.; Reinisch, John F.; Puckett, Charles L.

doi:10.1097/00006534-198111000-00012

Cited by 35 publications

(15 citation statements)

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“…Their efficacy in reversing microvascular thrombosis is well documented in the animal model. 81,82 Human studies are available but scant. In a retrospective multi-institutional study Yii et al 83 reported no significant improvement in patency with the use of thrombolytic therapy in freeflap salvage; however, Rooks et al 36 reported that for an established thrombus, urokinase results in marked improvement in patency compared with heparin and dextran.…”

Section: Dextranmentioning

confidence: 99%

Anticoagulation Therapy in Microsurgery: A Review

Askari

Fisher

Weniger

et al. 2006

The Journal of Hand Surgery

109

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Section: Dextranmentioning

confidence: 99%

Anticoagulation Therapy in Microsurgery: A Review

Askari

Fisher

Weniger

et al. 2006

The Journal of Hand Surgery

109

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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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“…Cell swelling ensues, because of ischaemic damage to the Na+-K + ATPase pump [15,27,33,48] and changes in vascular permeability as well as inflammatory changes cause interstitial oedema [33,48]. Altered vascular homeostasis occurs with diffuse vasoconstriction [27], increased platelet aggregation and altered fibrin metabolism, resulting in thrombus formation [19,31]. Finally, oxygen-derived free radicals are produced during ischaemia and reperfusion, thus initiating further tissue damage [34].…”

Section: Introductionmentioning

confidence: 99%

Interaction between thromboxane and free radical mechanisms in experimental ischaemic rabbit skin flaps

et al. 1990

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The possible relationship between increased blood levels of thromboxane (TXA2) and tissue levels of free radicals during ischaemia was investigated. Rabbit epigastric skin flaps were subjected to 4 h of body temperature ischaemia, then infused with either the TXA2 synthetase inhibitor UK-38,485, the free radical scavenger superoxide dismutase (SOD), or both immediately prior to reperfusion. After 30 min of reperfusion, increases in the tissue levels of xanthine oxidase (XO) and malonyldialdehyde (MDA), both of which are indices of free radical generation and decreases in the tissue levels of SOD were found. SOD treatment completely restored XO, MDA and SOD levels to normal, whereas UK-38,485 only partially improved all three parameters. None of these changes was statistically significant. Effluent blood thromboxane B2 (TXB2) levels from the flap increased significantly (P less than 0.01) after ischaemia and were reduced significantly by both UK-38,485 and SOD (P less than 0.05). Combined UK-38,485 and SOD treatment was no better than treatment with either agent alone. ATP levels and oedema, which decreased and increased respectively due to ischaemia, were not significantly altered by drug infusion. These results suggest that free radical damage may be related to TXA2-generated thrombosis in ischaemia/reperfusion injury.

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Microvascular Fibrinolysis after Ischemia: Its Relation to Vascular Patency and Tissue Survival

Cited by 35 publications

References 0 publications

Anticoagulation Therapy in Microsurgery: A Review

Anticoagulation Therapy in Microsurgery: A Review

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

Interaction between thromboxane and free radical mechanisms in experimental ischaemic rabbit skin flaps

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