Ischemic tolerance of canine jejunal flaps.

Abstract:

:Reconstruction of the upper aerodigestive tract with free jejunal flaps is now an accepted alternative to more conventional techniques. Success rates for microsurgical transfer approach 100 percent; however, complications following this technique are reported despite technical success, ischemia being implicated as an important etiologic factor. A histologic analysis of canine jejunum subjected to progressively increasing normothermic ischemic periods was undertaken. One hundred canine jejunal flaps were randomly assigned ischemia times between 0 and 12 hours and evaluated 48 hours after reperfusion. Results indicate that (1) isolation of a segment of jejunum on a single pedicle results in no light microscopic changes, (2) histologic changes are evident after 30 minutes of warm ischemia, but gross changes are not evident until greater than 2 hours of ischemia, (3) histologic changes that occur with ischemic insults are progressive and cumulative, (4) mucosal ulcerations are evident at 3 hours, (5) partial-thickness muscle necrosis occurs in all segments at 4 hours, (6) 5 hours of ischemia results in spotty full-thickness necrosis of the bowel wall in 80 percent of the flaps, and (7) by 6 hours, full-thickness myonecrosis is present in all segments. Ischemic periods greater than 6 hours result in increasing histologic disarray.

journal_name

Plast Reconstr Surg

authors

Olding M,Jeng JC

doi

10.1097/00006534-199407000-00019

subject

Has Abstract

pub_date

1994-07-01 00:00:00

pages

167-73

issue

1

eissn

0032-1052

issn

1529-4242

journal_volume

94

pub_type

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