Although there have been many improvements in technical aspects of microsurgical reconstructive surgery using free tissue transfer, partial and complete flap failure due to ischemia reperfusion injury still remains a significant clinical problem. Our limited understanding of the pathophysiology of ischemia reperfusion injury has been a major impediment in developing interventions to prevent or minimize this injury in order to reduce patient morbidity associated with major reconstructive procedures. There has been profound interest in the role played by the gaseous free radical nitric oxide in ischemia reperfusion injury in cerebral, myocardial and intestinal tissue. The role of this molecule has not been clearly identified in ischemia reperfusion injured surgical flaps. It has been shown that skin exhibits less of a response to salvage strategies than does skeletal muscle. The objectives of this thesis were to characterize and compare the flow dynamics in reperfused skin and skeletal muscle flaps and to explore the role played by nitric oxide in attenuation of ischemia reperfusion injury in these flaps. In a series of three complementary experiments it was shown that (1) the effect of ischemia reperfusion injury on flow patterns varies significantly between flap skin and skeletal muscle. In flap skeletal muscle, an early hyperemic phase during reperfusion maintains a significant blood flow to all regions including the area of the flap that is destined for necrosis. In flap skin however, there is a marked decrease in flow rates. (2) Ischemia, reperfusion injury causes a significant decrease in the function and availability of constitutive nitric oxide synthase enzymes and (3) infusion of a nitric oxide donor during reperfusion significantly attenuates tissue injury.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.20288 |
| Date | January 1997 |
| Creators | Taghipour-Khiabani, Kayvan. |
| Contributors | Kerrigan, Carolyn L. (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Division of Surgical Research.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001604709, proquestno: MQ44293, Theses scanned by UMI/ProQuest. |
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