EXPERIMENTAL STUDY ON EFFECT OF POWER-ASSISTED INTRAVASCULAR SHUNT IN REPLANTATION OF AMPUTATED LIMBS IN RABBITS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIHonghui ¹ ,  ZHENGCanbin ² , HEHaihong ¹ , BAIZhi ¹ , ZHUQingtang ² , HUXiangyuan ¹

1. Department of Microsurgery, Tangxia Hospital of Dongguan, Dongguan Guangdong, 523710, P. R. China;
2. Department of Microsurgery and Orthopedic Trauma, the First Affiliated Hospital of Sun Yat-sen University;

Corresponding?author：

ZHENGCanbin, Email: zhengcanbin@qq.com

Keywords：

Power-assisted; Intravascular shunt; Ischemia reperfusion injury; Amputated limb; Rabbit

DOI：

10.7507/1002-1892.20140329

Video：

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Objective To investigate the effect of power-assisted intravascular shunt in replantation of amputated limbs of rabbits. Methods Eighty rabbits weighing 1.8-2.5 kg (male or female) were selected to establ ish the model of circular amputation at the hind groin, only femoral arteries and veins were completely preserved. After the femoral artery was clamped in 60 rabbits, the rabbits underwent power-assisted intravascular shunt with high-flow rate (group A, n=20), powerassisted intravascular shunt with low-flow rate (group B, n=20), and no power-assisted intravascular shunt (group C, n=20) to reconstruct blood supply; the femoral artery was not clamped in another 20 rabbits of sham group (group D). Before and after intravascular shunt (1, 3, 6, and 12 hours), the malondialdehyde (MDA), lactate dehydrogenase (LDH), and creatine kinase (CK) of the serum were determined. The myeloperoxidase (MPO), MDA, and wet to dry weight ratio (W/D ratio) of the gastrocnemius muscle were measured, and the thrombogenesis and survival rate of limb were observed. Results Before intravascular shunt, MDA, LDH, and CK of the serum and MPO, MDA, and W/D ratio of the muscle showed no significant difference among 4 groups (P>0.05). At each time point after intravascular shunt, no significant difference was found in all indexes between groups A and D (P>0.05); the indexes of groups B and C were significantly higher than those of groups A and D (P<0.05); the values were the highest in group C (P<0.05), and reached the peak at 12 hours. All limbs of group A survived with low thrombosis rate, and less limbs could survive with high thrombosis rate in group C. Conclusion The power-assisted intravascular shunt with high-flow rate can effective ensure the blood supply of the amputated limbs of rabbits with lower limb injury and higher survival rate of amputated limbs after replantation.

Citation： LIHonghui, ZHENGCanbin, HEHaihong, BAIZhi, ZHUQingtang, HUXiangyuan. EXPERIMENTAL STUDY ON EFFECT OF POWER-ASSISTED INTRAVASCULAR SHUNT IN REPLANTATION OF AMPUTATED LIMBS IN RABBITS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1519-1524. doi: 10.7507/1002-1892.20140329 Copy

1.	?Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1):67-70.
2.	劉建偉. 兔股動脈端端吻合術后的血流動力學研究. 吉林:北華大學, 2000.
3.	Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome:a review. Cardiovasc Surg, 2002, 10(6):620-630.
4.	鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷的傷情特點分析. 中華損傷與修復雜志(電子版), 2011, 6(4):557-563.
5.	王愛民. 重視四肢主要血管損傷的救治. 創傷外科雜志, 2004, 6(4): 241-242.
6.	Clouse WD, Rasmussen TE, Pecket MA, et al. In-theater management of vascular injury:2 years of the Balad Vascular Registry. J Am Coll Surg, 2007, 204(4):625-632.
7.	Rasmussen TE, Clouse WD, Jenkins DH, et al. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma, 2006, 61(1):8-15.
8.	Oliver JC, Gill H, Nicolet AJ, et al. Temporary vascular shunting in vascular trauma:a 10-year review from a civilian trauma centre. S Afr J Surg, 2013, 51(1):6-10.
9.	Fox CJ, Patel B, Clouse WD. Update on wartime vascular injury. Perspect Vasc Surg Endovasc Ther, 2011, 23(1):13-25.
10.	周敦, 許步偉, 王秀珊, 等. 血管臨時橋接技術在股骨近端開放骨折合并股動脈損傷中的臨床應用. 現代醫學, 2012, 40(6):712-713.
11.	朱慶棠, 鄭燦鑌, 戚劍, 等. 臨時血管轉流術在快速重建肢體血供中的應用. 中國修復重建外科雜志, 2012, 26(2):231-234.
12.	Desai P, Audige L, Suk M. Combined orthopedic and vascular lower extremity injuries:sequence of care and outcomes. Am J Orthop (Belle Mead NJ), 2012, 41(4):182-186.
13.	Ball CG, Kirkpatrick AW, Rajaniet RR, et al. Temporary intravascular shunts:when are we really using them according to the NTDB? Am Surg, 2009, 75(7):605-607.
14.	Corona BT, Rathbone CR. Accelerated functional recovery after skeletal muscle ischemia-reperfusion injury using freshly isolated bone marrow cells. J Surg Res, 2014, 188(1):100-109.
15.	Nanobashvili J, Neumayer C, Fügl A, et al. Ischemia/reperfusion injury of skeletal muscle:plasma taurine as a measure of tissue damage. Surgery, 2003, 133(1):91-100.
16.	鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷延誤修復的原因分析. 中華創傷骨科雜志, 2011, 13(4):392-394.
17.	彭軍, 張連元, 門秀麗, 等. 大鼠肢體缺血再灌注過程中血及骨骼肌的相應指標變化. 中國病理生理雜志, 2005, 21(7):1424-1425.
18.	Andrews K, Mowlavi A, Neumeister MW, et al. Ischemia-reperfusion injury:a multicellular phenomenon. Plast Reconstr Surg, 2000, 106(7): 1664-1665.
19.	梅晰凡, 劉暢, 王偉, 等. 酶組織化學法觀察缺血預處理對大鼠骨骼肌缺血再灌注損傷的保護作用. 中國臨床康復, 2006, 10(16):76-78.
20.	Novelli GP, Adembri C, Gandini E, et al. Vitamin E protects human skeletal muscle from damage during surgical ischemia reperfusion. Am J Surg, 1997, 173(3):206-209.
21.	劉國龍, 楊牟, 張居文, 等. 兔后肢急性缺血與伴行靜脈血栓形成關系的實驗研究. 青島大學醫學院學報, 2008, 44(3):254-255.

1. ?Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1):67-70.
2. 劉建偉. 兔股動脈端端吻合術后的血流動力學研究. 吉林:北華大學, 2000.
3. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome:a review. Cardiovasc Surg, 2002, 10(6):620-630.
4. 鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷的傷情特點分析. 中華損傷與修復雜志(電子版), 2011, 6(4):557-563.
5. 王愛民. 重視四肢主要血管損傷的救治. 創傷外科雜志, 2004, 6(4): 241-242.
6. Clouse WD, Rasmussen TE, Pecket MA, et al. In-theater management of vascular injury:2 years of the Balad Vascular Registry. J Am Coll Surg, 2007, 204(4):625-632.
7. Rasmussen TE, Clouse WD, Jenkins DH, et al. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma, 2006, 61(1):8-15.
8. Oliver JC, Gill H, Nicolet AJ, et al. Temporary vascular shunting in vascular trauma:a 10-year review from a civilian trauma centre. S Afr J Surg, 2013, 51(1):6-10.
9. Fox CJ, Patel B, Clouse WD. Update on wartime vascular injury. Perspect Vasc Surg Endovasc Ther, 2011, 23(1):13-25.
10. 周敦, 許步偉, 王秀珊, 等. 血管臨時橋接技術在股骨近端開放骨折合并股動脈損傷中的臨床應用. 現代醫學, 2012, 40(6):712-713.
11. 朱慶棠, 鄭燦鑌, 戚劍, 等. 臨時血管轉流術在快速重建肢體血供中的應用. 中國修復重建外科雜志, 2012, 26(2):231-234.
12. Desai P, Audige L, Suk M. Combined orthopedic and vascular lower extremity injuries:sequence of care and outcomes. Am J Orthop (Belle Mead NJ), 2012, 41(4):182-186.
13. Ball CG, Kirkpatrick AW, Rajaniet RR, et al. Temporary intravascular shunts:when are we really using them according to the NTDB? Am Surg, 2009, 75(7):605-607.
14. Corona BT, Rathbone CR. Accelerated functional recovery after skeletal muscle ischemia-reperfusion injury using freshly isolated bone marrow cells. J Surg Res, 2014, 188(1):100-109.
15. Nanobashvili J, Neumayer C, Fügl A, et al. Ischemia/reperfusion injury of skeletal muscle:plasma taurine as a measure of tissue damage. Surgery, 2003, 133(1):91-100.
16. 鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷延誤修復的原因分析. 中華創傷骨科雜志, 2011, 13(4):392-394.
17. 彭軍, 張連元, 門秀麗, 等. 大鼠肢體缺血再灌注過程中血及骨骼肌的相應指標變化. 中國病理生理雜志, 2005, 21(7):1424-1425.
18. Andrews K, Mowlavi A, Neumeister MW, et al. Ischemia-reperfusion injury:a multicellular phenomenon. Plast Reconstr Surg, 2000, 106(7): 1664-1665.
19. 梅晰凡, 劉暢, 王偉, 等. 酶組織化學法觀察缺血預處理對大鼠骨骼肌缺血再灌注損傷的保護作用. 中國臨床康復, 2006, 10(16):76-78.
20. Novelli GP, Adembri C, Gandini E, et al. Vitamin E protects human skeletal muscle from damage during surgical ischemia reperfusion. Am J Surg, 1997, 173(3):206-209.
21. 劉國龍, 楊牟, 張居文, 等. 兔后肢急性缺血與伴行靜脈血栓形成關系的實驗研究. 青島大學醫學院學報, 2008, 44(3):254-255.

Chinese Journal of Reparative and Reconstructive Surgery

EXPERIMENTAL STUDY ON EFFECT OF POWER-ASSISTED INTRAVASCULAR SHUNT IN REPLANTATION OF AMPUTATED LIMBS IN RABBITS

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