Guanethidine이 백서 피부판에 미치는 효과에 대한 실험적 연구

Abstract

[한글]

피부판의 생존은 성형외과 영역의 중요한 문제의 하나로 피부판의 생존을 증대시키기 위하여 다음 몇가지 사항을 고려하여야 한다. 첫째, 피부판의 크기와 위치, 둘째, 피부판의 혈액공급을 증대시키기 위한 지연형성, 세째, 피부판의 지속적인 혈액공급의 유지 등

이다. 위의 고려사항 중 피부판의 지연형성은 성형외과에서 자주 이용되는 방법으로 피부판의 생존을 보다 더 확실히 하기 위하여 피부판의 전이를 여러단계로 나누어 시행하는 것을 말한다. 이러한 피부판의 지연형성에는 몇가지 방법이 있는데, 즉 외과적 지연형성

(surgical delay), 약물적 지연형성 (pharmacological Delay)과 전기적 지연형성 (electrical delay) 등이 있다.

이 실험의 목적은 교감신경 차단약물인 guanethidine을 사용하여 약물적 지연형성을 관할함에 있다.

Hannington-Kiff(1974)는 환자의 상하지에서 guanethidine을 사용하여 효과적인 교감신경 차단을 유도하였고, Finseth과 Ade1berg(1978)는 혈관확장제를 백서에 투여하여 신경맥관 도서형 피부판 (neurovascular island flap)의 괴사를 방지하였다고 보고하였다. Aarts(1980)는 가토의 이개에서 guanethidine을 지역적 교감신경차단제 (regional sympathetic blocking agent)로 사용하여 피부판 생존을 현저히 증대시켰다고 하였다.

이 실험에서는 첫째, guanethidine이 백서의 신경맥관 도서형 피부판 (neurovascular island flap) 이외에 임의형 피부판 (random Pattern flap) 에서도 피부판의 괴사를 방지할 수 있는지, 둘째. guanethidine을 국소적 (local)으로 사용하여도 피부판의 생존증대에 효과가 있는지를 알아보려고 하였다.

실험결과는 guanethidine을 전신적으로 투여한 백서의 신경맥관 도서형 피부판 (neurovascular island flap) 생존은 현저한 증대를 보였으나, 임의형 피부판 (random pattern flap)에서는 생존 증대에 별다른 영향을 미치지 않는 것으로 나타났다.

Guanethidine을 국소적으로 투여한 백서에서는 임의형 피부판 (random pattern 리ap)과 신경맥관 도서형 피부판 (neurovascular island flap) 모두에서 효과가 없는 것으로 나타났다.

결론은 guanethidine을 전신적으로 투여한 백서의 신경맥관 도서형 피부판 (naurovaacular island flap )에서는 확실한 약물적 지연형성 (pharmacological delay) 효과가 나타났으나, 임의형 피부판(random pattern flap )에서는 별다른 효과가 없었다. Guanethidine을 국소적으로 투여한 백서에서는 신경맥관 도서형 피부판 (neurovascular island flap ) 과 임의형 피부판(random pattern flap) 양쪽 모두에서 약물적 지연형성 (pharmacological delay) 효과가 없는 것으로 나타났다.

The Effect of Guanethidine on Flap Survival in Rats.

Joon Choe, M.D.

Department of Medical Science, The Graduate School Yonsei University

(Directed by Prof. Jae Duk Lew, M.D.)

Flap survival is still a major problem in reconstructive surgery. To increase

flap survival, the matters that must be considered are the size and location of the

flap that can be supported by the available blood supply, delaying the flap to

increase Its blood supply, and maintaining the blood supply present In the flap.

The term delaying a flap is frequently used in the field of reconstructive surgery

to indicate that the flap is being developed and transferred in more than a sing1e

stage to ensure its safety. There are various methods in delaying flap; surgical

delay pharmacological delay and electrical delay.

After Bier (1908), Hanning-Kiff (1974) produced an effective sympathetic blockade

with guanethidine in the upper and lower extremities of patient. Finseth (1978)

described the prevention of skin flap necrosis by a course of treatment with

vasodilating drugs. Aarts (L98O) reported extremely Increased flap survival in

rabbit ear by regional sympathetic blockade with guanethidine. Aim of this study is

to clarify the effectiveness of the pharmacological delay by using the guanethidine

which is a sympathetic ganglionic blocking agent.

The experiments were carried out to confirm that whether the guanethidine could

prevent flap necrosis in neurovascular island flaps and random pattern flaps in

rats, and also the effectiveness of the drug could be different by way of

administration.

The results demonstrated that the rats which were pretreated with guanethidine

systemically showed significant improvement in the survival of neurovascular island

flap, but there were little Improvement in the survival of random pattern flap.

However, when the rats were treated with guanethidine locally for 10 minutes before

the flap were raised, there was no improvement in flap survival.

In conclusion, when the guanethidine was administered systemically, there was

significant pharmacological delay effect on neurovasuclar island flaps, but no

effect on random pattern flaps. When the guanethidine was administered locally,

there was no pharmacological delay effect on either pattern flaps.

[영문]

Flap survival is still a major problem in reconstructive surgery. To increase flap survival, the matters that must be considered are the size and location of the flap that can be supported by the available blood supply, delaying the flap to increase Its blood supply, and maintaining the blood supply present In the flap.

The term delaying a flap is frequently used in the field of reconstructive surgery to indicate that the flap is being developed and transferred in more than a sing1e stage to ensure its safety. There are various methods in delaying flap; surgical

delay pharmacological delay and electrical delay.

After Bier (1908), Hanning-Kiff (1974) produced an effective sympathetic blockade with guanethidine in the upper and lower extremities of patient. Finseth (1978)

described the prevention of skin flap necrosis by a course of treatment with vasodilating drugs. Aarts (L98O) reported extremely Increased flap survival in rabbit ear by regional sympathetic blockade with guanethidine. Aim of this study is

to clarify the effectiveness of the pharmacological delay by using the guanethidine which is a sympathetic ganglionic blocking agent.

The experiments were carried out to confirm that whether the guanethidine could prevent flap necrosis in neurovascular island flaps and random pattern flaps in rats, and also the effectiveness of the drug could be different by way of administration.

The results demonstrated that the rats which were pretreated with guanethidine systemically showed significant improvement in the survival of neurovascular island flap, but there were little Improvement in the survival of random pattern flap.

However, when the rats were treated with guanethidine locally for 10 minutes before the flap were raised, there was no improvement in flap survival.

In conclusion, when the guanethidine was administered systemically, there was significant pharmacological delay effect on neurovasuclar island flaps, but no effect on random pattern flaps. When the guanethidine was administered locally, there was no pharmacological delay effect on either pattern flaps.