Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration

Dong Wei; Jiong Lyu; Bo Wang; Yong He; Ling Bi

doi:10.1016/j.jormas.2024.101868

Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration

J Stomatol Oral Maxillofac Surg. 2024 Apr 6:101868. doi: 10.1016/j.jormas.2024.101868. Online ahead of print.

Authors

Dong Wei¹, Jiong Lyu¹, Bo Wang², Yong He³, Ling Bi⁴

Affiliations

¹ Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China.
² Department of Pathology, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China.
³ Laboratory Animal Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China.
⁴ Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China. Electronic address: lingbi@zju.edu.cn.

PMID: 38588856
DOI: 10.1016/j.jormas.2024.101868

Abstract

Background and purpose: Hirudin, a potent anticoagulant, is used in traditional Chinese medicine (TCM) to treat thrombotic conditions and prevent postoperative thrombosis. Coagulation-related vascular complications are a common cause of perforator flaps failure. This study explores hirudin's potential to enhance flap growth by mitigating coagulation-related issues.

Materials and methods: Patients were divided into GroupⅠ(hirudin group) and GroupⅡ(control). Laboratory tests covered red blood cell count (RBC), hematocrit (HCT), platelet count (PLT), monocyte count (MONO), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-Dimer. Clinical parameters, including capillary refill time (CRT), flap swelling, and survival status, were evaluated. Animal experiments used Sprague-Dawley (SD) rats to establish random skin flaps. The experimental side received hirudin injection, while the control side received saline. Flaps were photographed to calculate survival rate, and CD31 immunohistochemical (IHC) analysis was performed to calculate microvessel density (MVD).

Results: The study, with 29 patients, found significant CRT differences between groups on postoperative days 2 and 6 (p = 0.027; p = 0.019), favoring GroupⅠ. Swelling severity varied significantly over time; GroupⅡhad more pronounced swelling. GroupⅠshowed superior flap growth with fewer complications, statistically significant (p = 0.033). Specific lab indicators (MONO, PT, and FIB) were significant at certain times. In animal experiments, the experimental side consistently had higher flap survival and slightly increased CD31 expression at various times, with higher MVD on days 2 and 6.

Conclusions: Hirudin enhances flap survival through diverse mechanisms, supporting its role as a complementary approach in perforator flap surgeries.

Keywords: Hirudin; Oro-maxillofacial surgery; Perforator flap; Reconstructive surgery; Traditional Chinese medicine; Venous crisis.