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.	刘建伟. 兔股动脉端端吻合术后的血流动力学研究. 吉林:北华大学, 2000.
3.	Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome:a review. Cardiovasc Surg, 2002, 10(6):620-630.
4.	郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤的伤情特点分析. 中华损伤与修复杂志(电子版), 2011, 6(4):557-563.
5.	王爱民. 重视四肢主要血管损伤的救治. 创伤外科杂志, 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, 许步伟, 王秀珊, 等. 血管临时桥接技术在股骨近端开放骨折合并股动脉损伤中的临床应用. 现代医学, 2012, 40(6):712-713.
11.	朱庆棠, 郑灿镔, 戚剑, 等. 临时血管转流术在快速重建肢体血供中的应用. 中国修复重建外科杂志, 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.	郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤延误修复的原因分析. 中华创伤骨科杂志, 2011, 13(4):392-394.
17.	彭军, 张连元, 门秀丽, 等. 大鼠肢体缺血再灌注过程中血及骨骼肌的相应指标变化. 中国病理生理杂志, 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, 刘畅, 王伟, 等. 酶组织化学法观察缺血预处理对大鼠骨骼肌缺血再灌注损伤的保护作用. 中国临床康复, 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.	刘国龙, 杨牟, 张居文, 等. 兔后肢急性缺血与伴行静脉血栓形成关系的实验研究. 青岛大学医学院学报, 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. 刘建伟. 兔股动脉端端吻合术后的血流动力学研究. 吉林:北华大学, 2000.
3. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome:a review. Cardiovasc Surg, 2002, 10(6):620-630.
4. 郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤的伤情特点分析. 中华损伤与修复杂志(电子版), 2011, 6(4):557-563.
5. 王爱民. 重视四肢主要血管损伤的救治. 创伤外科杂志, 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, 许步伟, 王秀珊, 等. 血管临时桥接技术在股骨近端开放骨折合并股动脉损伤中的临床应用. 现代医学, 2012, 40(6):712-713.
11. 朱庆棠, 郑灿镔, 戚剑, 等. 临时血管转流术在快速重建肢体血供中的应用. 中国修复重建外科杂志, 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. 郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤延误修复的原因分析. 中华创伤骨科杂志, 2011, 13(4):392-394.
17. 彭军, 张连元, 门秀丽, 等. 大鼠肢体缺血再灌注过程中血及骨骼肌的相应指标变化. 中国病理生理杂志, 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, 刘畅, 王伟, 等. 酶组织化学法观察缺血预处理对大鼠骨骼肌缺血再灌注损伤的保护作用. 中国临床康复, 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. 刘国龙, 杨牟, 张居文, 等. 兔后肢急性缺血与伴行静脉血栓形成关系的实验研究. 青岛大学医学院学报, 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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