複合組織移植における血行障害に対する持続動脈内注入法に関する実験的研究

Abstract

Causes of unsuccessful replantation after major or minor amputation and tissue transplantation include postoperative thrombosis of the anastomotic site, which is caused by narrowing of the recipient vessels secondary to intimal injury due to trauma and rediation therapy, and no-reflow phenomenon as a result of prolonged interval between completion of vascular anastomosis and reperfusion of the vessels in addition to unskillful vascular anastomosis. Systemic administration of anticoagulants and fibrinolytic agents has the primary measure for the prevention of postoperative thrombosis of the anastomdc site, but the success rate of these operations has not reached 100%. So, it was considered that direct infusion of these drugs into the regional artery may be more effective for improving the results of replanted or transplanted tissue. After determining the minimum necessary rates of local intra-arterial infusion of heparin and urokinase by preliminary experiments, we compared the take of a free flap thrombosis model by administering these agents intra-arterially or systemicarlly from the middle of the operation to examine the effectiveness of local intra-arterial administration. Next, since fibrinolytic agents such as streptokinase and urokinase are reported to be effective for the prevention of no reflow phenomenon, the effectiveness of continuous local intra-arterial administration of anticoagulants and fibrinolytic agents for the prevention of reperfusion injury was examined in an ischemic flap model. Comparative evaluation using redical scavengers indicated that their concomitant use beneficial if ischemia is prolonged.