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KMID : 0988420030150020124
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Journal of Dental Science (C.N.U.)
2003 Volume.15 No. 2 p.124 ~ p.135
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Effects of Topical and Intravenous Heparin on Thrombosis of Microvascular Anastomoses
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Abstract
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The need of microvascular anastomosis or vascular graft has been increased gradually to reconstruct the maxillofacial defects. Despite advances in microsurgical technique, instrumentation and experience gained in clinical microvascular surgery, thrombosis of small veins may lead to the failure of microvascular surgery. A variety of anticoagulant agents have been used in either experimental or clinical microvascular surgery in order to decrease the failure rate of microvascular anastomosis and to prevent the need of reoperation. Heparin, which has been known to be effective in preventing thrombosis and in improving patency after microvascular anastomosis, is used locally or systematically. However, their effects is controversial.
This study was performed to evaluate the effect of topical and intravenous heparin on thrombosis and patency in the microvascular anastomosis of the traumatized veins. Nine white rabbits wishing about 2 kg were used. After exposure of both femoral veins, the veins were crushed by the jaws of smooth needle holder in order to create a thrombosis model. Transectional incision was made in the vein. The animals were then divided into 3 groups based on the administration method of heparin: 1) Experimental Group 1, topical irrigation of lumen with heparin saline solution (n=6); 2) Experimental Group 2, topical irrigation of lumen with heparin saline solution and intravenous injection of heparin (0.75 mg/kg) via the marginal ear vein for 3 days; 3) Control Group. topical irrigation of lumen with saline solution (n=6). The veins were anastomosed utilizing microvascular technique with 10-0 Ethilon.
The vascular patency was evaluated with empty-and-refill test 30 minutes and 3 days after microvascular anastomosis. The amount of thrombus was evaulated by surgery microscope 3 days after microvascular anastomosis and histologic findings were observed.
The results are as follows:
1. Thirty minutes after microvascular anastomosis, the patency of all Experimental Groups was better than Control group. However, there was no significant difference among groups.
2. Three days after anastomosis, the patency of all Experimental Groups was much more improved than that of Control Group (p<0.05). There was no significant difference between Experimental Group 1 and 2.
3. Three days after anastomosis, the amount of thrombus in all Experimental Groups was much less than that of Control Group (p<0.05).
4. In histologic findings a lot of luminal thrombus were observed around sutured area in Control Groups. Few luminal thrombus was observed in all Experimental Groups. Mild necrosis in the vessel wall was observed around sutured area in all specimens.
These results indicate that topical irrigation of heparin may improve the patency and inhibit the formation thrombus in the microvascular anastomosis of the traumatized veins.
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