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Aprotinin in Ischemia‐Reperfusion injury: Flap survival and neutrophil response in a rat skin flap model
Author(s) -
Stadelmann Wayne K.,
Hess Derek B.,
Robson Martin C.,
Greenwald Daniel P.
Publication year - 1998
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/(sici)1098-2752(1998)18:6<354::aid-micr2>3.0.co;2-v
Subject(s) - aprotinin , medicine , ischemia , saline , reperfusion injury , surgery , anesthesia
Multiple drugs have been used in experimental skin flap models to reduce the effects of reperfusion ischemia. The effects of antiproteases, however, have not been studied. A skin flap ischemia reperfusion model was developed in the rat to study the effects that aprotinin, a broad‐spectrum antiserine protease, would have on skin flap viability. Thirty‐two male rats underwent elevation of a ventral pedicled skin flap based on the superficial inferior epigastric artery. The flaps were subjected to 10 hr of warm ischemia by clamping the neurovascular pedicle followed by reperfusion. Aprotinin or saline (control) was administered systemically via the contralateral femoral vein either before or after the ischemic insult. Full‐thickness skin biopsies were obtained at 1, 8, and 24 hr into reperfusion. Biopsies were evaluated for neutrophil concentration (using a myeloperoxidase [MPO] assay) and thromboxane B 2 [TxB 2 ] content. Flap survival was calculated at 1 week using standardized photography and computer‐assisted digital imaging. Aprotinin given before an ischemic insult significantly improved flap survival compared to saline controls (52.3% alive vs. 29.6%, P = 0.0132, unpaired t ‐test). Aprotinin given after ischemia did not significantly influence flap survival (28.8% vs. 34.4% in saline controls, P = 0.708). MPO levels in the aprotinin preischemia treatment group were significantly less at 1 and 8 hr into reperfusion, indicating decreased neutrophil numbers. No statistical difference in TxB 2 levels was noted in either group at any time after reperfusion. Aprotinin significantly improves skin flap survival when given prior to but not after an ischemic insult. Aprotinin appears to lower the concentration of neutrophils in skin flaps pretreated with the drug. Reperfused skin flap levels of thromboxane B 2 are unaffected by the pre‐ or postischemic administration of aprotinin. © 1998 Wiley‐Liss, Inc. MICROSURGERY 18:354–361, 1998