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KMID : 0350519930460041543
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Journal of Catholic Medical College
1993 Volume.46 No. 4 p.1543 ~ p.1556
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The Effect of Pentoxifylline on the Patency Rate and Reendothelialization after Microvascular Anastomosis in Diabetic Rats
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Lee Hang-Won
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Abstract
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Diabetes mellitus is known as the most common endocrine disease and the true frequency is difficult to be certain, but it occupies probably between 1 and 2 perecent of general population. In the field of plastic surgery, the cases of
reconstructive
surgery for the injuries due to traffic or industrial accidents and diabetic foot ulcers are increased recently. For the reconstruction of such diseases the practice of microvascular surgery continues to expand because it has several advantages,
but it
is known that the risk of anastomotic failure remains high in diabetic patients.
Late diabetic complications such as nephropathy and retinopathy occur mainly due to the microangiopathy, and atherosclerotic dieseases such as coronary heart disease and peripheral vascular disease are accelerated in diabetes mellitus. The
mechanism of
development of diabetic vascular disease is incompletely understood. Hemorrheological changes, i.e. the blood hyperviscosity and the reduced erythrocyte deformability, occur frequently in diabetic patients. In recent years, several investigations
have
presented evidence that diabetic hemorrheological alterations may be involved in the occurrence of microvascular and macrovascular deggenerative complications. The xanthine derivative, i.e. pentoxifylline, has been used successfully in the
treatment of
pathohemor heological alterations accociated with diabetic vascular complications. In fact, pentoxifylline is able to improve erythrocyte deformability and to reduce blood viscosity and plasma fibrinogen levels.
This study was undertaken to evaluate the efficacy of pentoxifylline on microvascular anastomotic failure in a diabetic animal model. The 120 male wistar rats were divided into three groups that were control group, diabetic group and
diabetic-pentoxifylline treated group. Diabetes mellitus was induced by streptozotocin(50 mg/kg body weight intravenous injection) and the microvascular ananstomoses of the right femoral arteries were performed at 2 weeks after the induction of
diabetes. The diabetic-pentoxifylline treated group received intraperitoneal injections of pentoxifylline in dose of 20 mg/kg per day beginning at 24 hours prior to operation, which was continued daily for 14 days postoperatively. Body weight and
blood
glucose level were recorded preoperatively and on the 14th postoperative day. Patency of the anastomotic site was examined grossly using patency test and the anastomotic vessel segments were obtained for histologic study on the 14th postoperative
day.
The endothelial changes were observed with scanning electron microscope.
@ES The results were as follows ;
@EN 1. Pentoxifylline had no effect on glucose level and body weight
2. The patency rate of the diabetic group(81.08%) was decreased(chi-square test, P=0.0054) compared with that of the control group (100%), but the patency rete of the diabetic-nentoxifylinene treated group(97.14%) was significantly
increased(P=0.0301)
compared with that of the diabetic group.
3. The average non-reendothelialized area of microvascular anastomotic site of the diabetic group(8,465±8,319㎛*) was incresed compared with that of control group(273+401㎛*) was increased compared with that of control group(273±401㎛*)
electronmicroscopically. Pentoxifylline accelerated reendothelialization significantly in the diabeticpentoxifyllinel treated group(1,940±1,334㎛*, P=0.0002).
4. On the 14th postoperative day, endothelial cells covered the suture thread completely in the control group, but they appeared around the suture sparsely and irregularly in the diabetic group. In the diabetic-pentoxifylline treated group, the
endothelial cells covered a part of suture thread and they were arranged in regular fashion simiar to the findings of the control group on the 14th postoperative day.
These results suggest that diabetes mellitus has an adverse influence on anastomotic patency and endothelial healing after microvascular surgery, which can be improved by pentoxifyllinel treatment.
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