Floor plan - 2013 Annual Meeting - American Association for Hand ...

The Use of Thrombolytics in Microvascular Free Flaps
Institution where the work was prepared: NYU Medical Center, New York, NY, USA
Otway Louie; Pierre Saadeh; Jamie Levine; NYU Medical Center
BACKGROUND:
Microvascular reconstruction has emerged as a highly reliable method of reconstruction, with free flap success rates well over 90%. However,
flap failures do occur, often secondary to venous or arterial thrombosis. The use of thombolytics has been proposed by some to aid in salvage
of compromised flaps. The purpose of this study was to review our experience with thrombolytics in the salvage of microvascular free
flaps.
METHODS:
A retrospective review of all microvascular free flaps performed at NYU Medical Center from 2001 to 2007 was performed. Patients
requiring emergent re-exploration for impending flap failure were identified. The findings upon re-exploration were analyzed, as well
as the methods of management and final outcome.
RESULTS:
Over the course of 5 years, 418 microvascular free flaps were performed in 388 patients. Overall flap survival was 96.2%. There were 53
cases (12.7%) where emergent re-exploration was performed. Re-exploration was for hematoma in 19 patients, venous congestion or
thrombus in 25 patients, and arterial thrombus in 5 patients. Thrombolytics were used in 14 patients; 10 of these flaps had successful
salvage (71%), whereas 4 resulted in flap failure. Of the 24 patients with pedicle thrombosis treated without thrombolytics, 13 flaps were
salvaged (54%). The majority of flaps salvaged were re-explored in the zero to seven day post-operative interval.
CONCLUSIONS:
Microvascular free flap reconstruction can be performed with high success rates. The use of thrombolytics may offer a slight advantage in
the salvage of thrombosed flaps. Close post-operative monitoring and expeditious re-exploration are essential for successful flap salvage.
Ischemia/reperfusion-induced Apoptotic Endothelial Cells Isolated from Rat Skeletal Muscle
Institution where the work was prepared: University of Nevada School of Medicine, Las Vegas, NV, USA
Wei Z. Wang, MD; Xin-Hua Fang, MT; Linda L. Stephenson, MT; Kayvan T. Khiabani, MD; William A. Zamboni, MD;
University of Nevada School of Medicine
BACKGROUND:
Necrosis was considered to be the solo mechanism for ischemia/reperfusion (I/R)-induced cell death. Our previous study has demonstrated
that ischemia followed by reperfusion not only causes cell necrosis, but also accelerates cell apoptosis in the cells isolated from
rat skeletal muscle. However, the cell types of these apoptotic cells from skeletal muscle still need to be identified. The purpose for the
present study was to investigate I/R-induced apoptotic endothelial cells isolated from rat skeletal muscle.
MATERIALS/METHODS
A vascular pedicle isolated rat gracilis muscle model was used. After surgical preparation, clamps were applied on vascular pedicle to
create 4h of ischemia and released for reperfusion (I/R, n=10). Clamping was omitted in sham I/R rats (sham I/R, n=10). The muscle sample
was harvested after 24h of reperfusion and incubated with collagenase IA followed by EDTA and rat's own serum. Cells were filtered
through a sieve and collected by sedimentation. One million cells from each sample were stained by monoclonal anti-CD146-
Fluorescein (a principal marker for endothelial cells) and Annexin-V-Phycoerythrin to detect and quantify apoptotic endothelial cells.
Twenty thousand cells from each sample were scanned and analyzed by flow cytometry.
RESULTS:
The average percentage (±SEM) of CD146-Fuorescein-positive cells was 21.0±2.9% suggesting these cells are endothelial cell. In total
isolated cells, the average percentage of apoptotic cells was 18.3±1.8% in I/R group vs. 5.5±0.3% in the sham I/R group that suggesting
there was a statistically significant apoptosis (P=0.001) in the post-I/R cells. In CD146-negative cells, the average percentage of apoptotic
cells was 1.4±0.4% in I/R group vs. 1.3±0.1% in the sham I/R group that suggesting there was no significant apoptosis either in
sham I/R or after I/R in non-endothelial cells. However, in CD146-positive cells, the average percentage of apoptotic cells was 38.6±1.0%
in I/R group vs. 19.4±0.3% in the sham I/R group that suggesting there was a statistically significant apoptosis (P