적절한 정맥 재혈류 시점의 판단을 위한 조직산소분압의 유효성

Abstract

Purpose: The purpose of this study was to delineate the optimal time of venous revascularization for preventing the flap necrosis due to venous occlusion, and to clarify the usefulness of tissue oxygen pressure(TcpO2) in the determination of the point of time for venous revascularization. Methods: Thirty - six, 3 * 3 cm sized epigastric island flap was elevated in left abdomen of male Sprague - Dawley rat weighing 250 gram. Flaps were randomly assigned to six groups of six flaps according to the duration of venous occlusion with microvascular clamp; 10 minutes in the group Ⅰ as the control, 60 minutes in the group Ⅱ, 2 hours in the group Ⅲ, 3 hours in the group Ⅳ, 4 hours in the group Ⅴ, and 6 hours in the group Ⅵ. Just before removal of clamp after flap was reposed in situ, the ratio of TcpO2(tissue oxygen pressure) of the island flap to that of right abdomen was calculated in each group, and tissue specimen was harvested from the distal area of the flap for histological evaluation of vascular change. Five days later, survival area of the flap was estimated, and evaluated the correlation between the tissue oxygen pressure and the rate of flap survival. Results: The TcpO2 and the survival rate of flap were decreased proportionally with the duration of venous occlusion. The ratio of the TcpO2 of the flap is decreased abruptly to below sixty percentile compared to the TcpO2 of normal tissue, and the survived area of the flap is decreased to nine - tenth of the designed size after three hours of total venous occlusion. Histologically, the number of congested vessels was increased according to venous occluded time, and proportionally increased after 3 - hours of occlusion significantly. Conclusions: There is a close correlation between the TcpO2 and the survival rate of flaps according to the duration of venous occlusion. Therefore, the TcpO2 represents the hemodynamic changes within the flap, and thought to be an alternative effective tool in the flap monitoring for venous revascularization.