Conditioning of myocutaneous flaps.
OBJECTIVE
The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations.


METHODS
In an attempt to increase the ischaemic tolerance, 20 myocutaneous flaps (rectus abdominis muscle) in pigs were elevated and perfused with various, established solutions prior to the onset of ischaemia. The flaps were elevated, utilizing the superior epigastric vessels as the pedicle. Ten flaps were flushed with the University of Wisconsin solution, five with the Euro-Collins solution and the last five with a Ringer-Lactate solution, prior to the 6h long, normothermic ischaemia. On the day of operation, the first, third, fifth, seventh and tenth postoperative day clinical examinations and thermography were performed as well as biopsies. Additionally, on the tenth postoperative day, the rate of necrosis was determined morphometrically as the average of three measurements.


RESULTS
Ten days after surgery, the flaps pretreated with the University of Wisconsin solution displayed a vital surface area of 89%, the Euro-Collins solution 23% and the Ringer-Lactate solution 14%. Histologically, muscle tissue proved to be more susceptible to ischaemia than skin.


CONCLUSIONS
Regarding the rectus abdominis flap in a pig model, the University of Wisconsin solution proved superior in the prevention of ischaemic injury compared with the Euro-Collins solution and Ringer Lactate. In accordance with the literature, muscle tissue proved to be more susceptible to ischaemia than skin in our study.
Eichhorn
Wolfgang
W
Department of Oral and Maxillofacial Surgery, General Hospital Balingen, Balingen, Germany. w.u.e@t-online.de
Blake
Felix A S
FA
Pohlenz
Philipp
P
Gehrke
Gerd
G
Schmelzle
Rainer
R
Heiland
Max
M
D000241:Adenosine / Q000627:therapeutic use; D000493:Allopurinol / Q000627:therapeutic use; D000818:Animals; D001706:Biopsy; D004198:Disease Susceptibility; D019074:Epigastric Arteries; D005978:Glutathione / Q000627:therapeutic use; D006085:Graft Survival; D006982:Hypertonic Solutions / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007511:Ischemia / Q000517:prevention & control; D019194:Ischemic Preconditioning / Q000379:methods; D007552:Isotonic Solutions / Q000627:therapeutic use; D023421:Models, Animal; D009336:Necrosis; D019188:Organ Preservation Solutions / Q000627:therapeutic use*; D011887:Raffinose / Q000627:therapeutic use; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D015424:Reperfusion; D000077325:Ringer's Lactate; D016038:Skin Transplantation / Q000379:methods* / Q000473:pathology; D013524:Surgical Flaps / Q000098:blood supply; D013552:Swine; D013817:Thermography; D013997:Time Factors; D014021:Tissue Preservation / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods*; D052096:Warm Ischemia / Q000379:methods
C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D007552:Isotonic Solutions; D019188:Organ Preservation Solutions; D000077325:Ringer's Lactate; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose