Critical Ischemia Time, Perfusion, and Drainage Function of Vascularized Lymph Nodes
| Autor: | Ming-Huei Cheng, Chin-Yu Yang, Hui-Yi Hsiao, Olivia A. Ho |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Time Factors Ischemia 030230 surgery Surgical Flaps Rats Sprague-Dawley 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Laser-Doppler Flowmetry medicine Lymphatic vessel Animals Lymphedema Lymph node business.industry Lymphography Laser Doppler velocimetry medicine.disease Rats medicine.anatomical_structure Lymphatic system chemistry 030220 oncology & carcinogenesis Surgery Lymph Nodes Lymph Nuclear medicine business Perfusion Indocyanine green |
| Zdroj: | Plastic and Reconstructive Surgery. 142:688-697 |
| ISSN: | 0032-1052 |
| DOI: | 10.1097/prs.0000000000004673 |
| Popis: | BACKGROUND Vascularized lymph node transfer is a promising surgical treatment for lymphedema. This study investigated the effect of ischemia on the lymphatic drainage efficiency of vascularized lymph node flaps and the critical ischemia time of lymph nodes. METHODS Twenty-four lymph nodes containing groin flaps in 12 Sprague-Dawley rats were dissected. Clamping of the vascular pedicle was performed for 0, 1, 3, 5, 6, or 7 hours; then, each was allowed to reperfuse by means of the vascular pedicle for 1 hour. Perfusion and ischemic changes were assessed using indocyanine green lymphography; laser Doppler flowmetry; and histologic studies with associated lymphatic vessel endothelial hyaluronan receptor-1, CD68, 4',6-diamidino-2-phenylindole, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling, and glutathione assay stains. RESULTS The mean latency period of the groin lymph node flaps was 247 ± 67, 83 ± 15, 72 ± 42, 30 ± 18, and 245 ± 85 seconds in the 0-, 1-, 3-, 5-, and 6-hour groups, respectively. Perfusion detected by laser Doppler was 85.2 ± 14.5, 87.2 ± 36.7, 129.8 ± 33.7, 140.4 ± 148.5, 156.1 ± 91.4, and 41.2 ± 34.8 perfusion units at ischemia times of 0, 1, 3, 5, 6, and 7 hours, respectively. Cell damage measured by glutathione was 46.8 ± 10.2, 67.7 ± 14.2, 62.8 ± 15.4, 126.6 ± 5.9, 259.0 ± 70.3, and 109.1 ± 27.5 at ischemia times of 0, 1, 3, 5, 6, and 7 hours, respectively. Histologically, as ischemia time increased, hemorrhage and congestion became more severe. CONCLUSIONS The critical ischemia time of vascularized lymph nodes is 5 hours in the rodent animal model, verified by indocyanine green lymphatic fluid uptake, laser Doppler perfusion, and histologic assessments. Interestingly, lymphatic drainage and perfusion of vascularized lymph nodes were improved with an increased ischemia time before the critical 5 hours was reached. |
| Databáze: | OpenAIRE |
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