Evaluation of clinically applicable exsanguination treatments to alleviate venous congestion in an animal skin flap model.

Abstract

This study compares the effectiveness of alleviating venous congestion with mechanically-made outlets or leech therapy in promoting skin flap survival. Free flaps of abdominal skin (3 x 6 cm) were raised on Sprague-Dawley rats and subjected to ischemic events, simulating venous congestion. Animals received 1) no treatment; 2) two treatments involving two 18-gauge needle-puncture outlets; or 3) two sessions of leech therapy. Flap perfusion was monitored with a scanning laser Doppler flowmeter. Photographic images of flaps at 7 days were assessed for areas of normal tissue (n = 15), and laser Doppler flowmeter data consisted of control (n = 6), outlet (n = 6), and leech (n = 7). Both the needle-puncture outlet (40.0% +/- 9.24%) and leech treated (34.6% +/- 7.34%) groups had a significantly greater surviving skin area than untreated control flaps (8.0% +/- 5.0%), with 2 of 15 flaps receiving mechanical outlets exhibiting > 90% surviving area. After 7 days, laser Doppler flowmeter data showed greater mean perfusion in the outlet (71.7% +/- 16.8%) and leech (92.6% +/- 17.2%) treated groups, compared to controls (15.2% +/- 10.2%). There was a significant increase in perfusion in the outlet (13.3% +/- 6.2%) and leech (9.1% +/- 1.1%) treated groups from the end of secondary ischemia to day 7 (p < 0.05) compared to controls. The results suggest that two spatially separated outlets are as effective as one leech in increasing the area of surviving skin in venous congested flaps.

• Authors: P S Cottler, T J Gampper, G T Rodeheaver, T C Skalak
• Journal: Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society (Wound Repair Regen) 1999 May-Jun Vol. 7 Issue 3 Pg. 187-95 ISSN: 1067-1927 [Print] United States
• PMID: 10417755 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Analysis of Variance
• Animals
• Disease Models, Animal
• Exudates and Transudates
• Feasibility Studies
• Graft Survival
• Ischemia (therapy)
• Laser-Doppler Flowmetry
• Leeches
• Male
• Needles
• Phlebotomy (methods)
• Photography
• Punctures (instrumentation)
• Rats
• Rats, Sprague-Dawley
• Regional Blood Flow (physiology)
• Skin (blood supply)
• Skin Transplantation (pathology)
• Surgical Flaps (blood supply)
• Venous Insufficiency (therapy)