가토 대퇴동맥의 미세혈관 문합시 헤파린의 국소세척 및 전신투여 효과에 대한 실험적 연구

Abstract

Introduction : Despite the technical development of micro-anastomosis, there are considerable risks of failure because of the thrombosis. The failure rate of the free flap and digital replantation has been reported to be 5-10% and 15-30% each. The important factor of the successful microvascular surgery is not only the surgical technique but also the medical inhibitory procedure against the thrombus formation. Arteriotomy was carried out after the intentional injury on the vessel. Then the artery got local irrigation with heparin or systemic application by IV administration of heparin. The purpose of this study is to compare the histological patency rates of the anastomosis of the femoral artery. Materials and methods : The 12 rabbits which weigh about 2kg were included in this study. Both right and left femoral arteries of them were cut. The group with no damage on the vessel, saline irrigation , and micro-anastomosis was control group. The group with crush injury on the vessel, saline irrigation, and micro-anastomosis was experimental group I. The group with crush injury, saline irrigation, 100U/ml heparin irrigation, and micro-anastomosis was experimental group II. The group with the same treatment as the experimental group II and additional systemic application by 100U/kg heparin IV administration was experimental group III. The histological patency rates were compared. Results : The patency rate of control group 30 minutes and 3 days after the anastomosis was 100% and 83% each. That of experimental group I and II 30 minutes and 3 days after the anastomosis was 100% and 100% each. That of experimental group III was 100% and 83% each. Conclusions : No significant corelation of the patency rate was shown in the study on the effects of local irrigation and systemic application of heparin for the microvascular anastomosis of the femoral artery of the rabbit. However, the patency rate had tendency to reduce as longer time of surgery took, Increased bleeding was observed after systemic application of heparin. The obvious damage on the crush-injured vascular endothelium was detected by the histologic examination of the micro-anastomosed area. Also, some vessels which got crush injury showed thrombi attached to the vascular endothelium. But no preventive effect of heparin against thrombus formation was observed.