Evaluation of clinically applicable exsanguination treatments to alleviate venous congestion in an animal skin flap model.
This study compares the effectiveness of alleviating venous congestion with mechanically-made outlets or leech therapy in promoting skin flap survival. Free flaps of abdominal skin (3 x 6 cm) were raised on Sprague-Dawley rats and subjected to ischemic events, simulating venous congestion. Animals received 1) no treatment; 2) two treatments involving two 18-gauge needle-puncture outlets; or 3) two sessions of leech therapy. Flap perfusion was monitored with a scanning laser Doppler flowmeter. Photographic images of flaps at 7 days were assessed for areas of normal tissue (n = 15), and laser Doppler flowmeter data consisted of control (n = 6), outlet (n = 6), and leech (n = 7). Both the needle-puncture outlet (40.0% +/- 9.24%) and leech treated (34.6% +/- 7.34%) groups had a significantly greater surviving skin area than untreated control flaps (8.0% +/- 5.0%), with 2 of 15 flaps receiving mechanical outlets exhibiting > 90% surviving area. After 7 days, laser Doppler flowmeter data showed greater mean perfusion in the outlet (71.7% +/- 16.8%) and leech (92.6% +/- 17.2%) treated groups, compared to controls (15.2% +/- 10.2%). There was a significant increase in perfusion in the outlet (13.3% +/- 6.2%) and leech (9.1% +/- 1.1%) treated groups from the end of secondary ischemia to day 7 (p < 0.05) compared to controls. The results suggest that two spatially separated outlets are as effective as one leech in increasing the area of surviving skin in venous congested flaps.
Department of Biomedical Engineering, University of Virginia, Charlottesville 22908, USA.
P S
PS
Cottler
T J
TJ
Gampper
G T
GT
Rodeheaver
T C
TC
Skalak
D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D005122:Exudates and Transudates; D005240:Feasibility Studies; D006085:Graft Survival; D007511:Ischemia / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D007865:Leeches; D008297:Male; D009339:Needles; D018962:Phlebotomy / Q000379:methods*; D010781:Photography; D011677:Punctures / Q000295:instrumentation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012039:Regional Blood Flow / Q000502:physiology; D012867:Skin / Q000098:blood supply*; D016038:Skin Transplantation / Q000473:pathology*; D013524:Surgical Flaps / Q000098:blood supply*; D014689:Venous Insufficiency / Q000628:therapy*