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Author: SongBaoQiang
Tutor: GuoShuZhong
School: Fourth Military Medical University
Course: Surgery
Keywords: Flowmetry Pig skin Skin avulsion Molecule expression Experimental study Neutrophil Sodium fluorescein Secondary necrosis Adhesion molecule Organization Cycle
CLC: R622
Type: Master's thesis
Year: 2002
Downloads: 21
Quote: 1
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Skin avulsion injury is a common trauma in plastic surgery, the unkown mechanism of avulsed tissue secondary necrosis and the lack of effective techniques for the measurement of blood supply of avulsed tissue are the main factors that affect the results of the treatment. In this experiment, we have investigated the mechanism of secondary necrosis by study the expression of adhesive molecule after skin avulsion injury. At the same time, we have also developed a demofluorometer for the measurement of circulation in tissue.The experiment pigs were randomly divided into tow groups, one was used for reproducing the model of skin avulsion injury, subsequently, a 12x4cm random skin flap was elevated at the avulsion injury area of the hind leg of the pig, another was used for control, the same size skin flap was elevated at the hind leg of the pigs. Specimen of tissue and blood were collected at Oh, 2h, 6h, 12h, 24h after surgery. Polymorphonuclear neutrophils (PMNs) in peripheral vein were purified and a cell smear was made. 1. PMNs in tissue were estimated by myeloperoxidase (MPD) method indirectly. 2.CD-18mRNA in tissue was measured by applying PCR. 3. SP was employed to detect the expression of CD-lib on PMNs in peripheral vein and ICAM-1 on endothelial cells in tissue. The result showed that the expression of CD-lib, CD-18 and ICAM-1 in avulsion groups was obviously increased than that of control groups (P<0.05), the expression of them ascended gradually and reached the peak value at 12th hour after trauma in avulsion groups and descended slightly in following 12 hours, the trend of PMNs was according with them. The result hinted that there were high expression of adhesive molecule in early period of avulsion injury and they might play a importantrole in the adhesion between PMNs and endothelial cells and lead to the avulsed tissue secondary necrosis. The applying of monoclonal antibody of adhesive molecule might contribute to relieve the extent of tissue necrosis.In this study, we have developed a device, which was used to determine the tissue circulation. The device was designed on the rudiment of traditional fiuorescein method. Fluorescein sodium was injected intravenously and permeated to tissue. There is a good linearity between the content of fiuorescein sodium in tissue and regional blood flow. The specific wavelenghth light produced by the excitated light passed through the filter in the device, and irradiated fiuorescein sodium in the skin tissue, then the green yellow fluorescent emitted though the filter was converted to electric signal and amplified by the photomultiplier tube, the count represented regional flow was displayed through digital readout. The device was superiorer than the traditional fiuorescein method. The device was verified by the follwing experiment, l.To investigate and drawn the relational curves between the concentration of fiuorescein sodium and DF of demofluorometer. 2.To find the best dosage of fiuorescein sodium and its metabolism regularity in rabbit. 3.To study the relationship between circulation in rabbit skin flap tissue and DPI of demofluorometer. The results showed that the best measuring range should be 110"7~1 10"5 g/ml; 4mg/kg fiuorescein sodium was the best dosage;20min post administration is the best detecting time; The tissue would be survivable as DPI exceeding 60%, necrosis would happen when DPI was below 25%, If DPI was between 25% and 60%, the vigor of tissue cound not be sure. The application of the device is convenient, safe, sensitive and reliable.

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