ObjectiveTo study the development of methods assessing donor liver viability in liver transplantation.MethodsThe literature in the recent years on the methods of assessing donor liver viability was reviewed.ResultsFrom donor liver morphology to function,there have being developed many methods which assess donor liver viability,including:①donor liver appearance; ②intraoperative biopsies; ③donor liver microcirculation; ④portal pressure; ⑤enzymes levels in liver; ⑥lidocainemetabolizing activity; ⑦energy metabolism of donor liver; ⑧fat content in donor liver.ConclusionThere are many methods to assess the viability of donor liver. Each has its supericrity and defect respectively. Intraoperative biopsies, 31Pmagnetic resonance spectroscopy and portal pressure have more importance in clinical application.
SD mice were selected for Collin’s solution (4℃) infusion into the portal vein with different pressure to preserve the liver transplants. The following parameters were determined ①liver tissue aderine ribonucleotide including adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), ②cytoplasmic free Ca２＋ in single liver cell (［Ca２＋］i) and ③tissue pathologic ultrastructure change by highperformance liquid chromatography into quantimeter and pathologic examination respectively. The result suggested that with the infusion pressure becoming higher, the liver free Ca２＋(［Ca２＋］i), tissue aderine ribonucleotide, EC and tissue pathologic ultrastructure changed obviously. This result shows ［Ca２＋］i, EC and tissue aderine ribonucleotide might indicate the viability of liver transplant, and using low pressure infusion has benefit effect on liver preservation.Key wordsCold infusion pressureViability of liver transplantEnergy metabolismLiver cell free Ca２＋
OBJECTIVE In the determination of the viability of skin following incomplete avulsion, subjective criteria such as color, skin temperature, pressure reaction and the stab bleeding would often give a high rate of failure. In order to resolve this problem, a retrospective study was carried out. METHODS In 27 patients, there were 18 males and 9 females, the age ranged from 7 to 41 years old. In operation, the blood supply of the skin was determined by above subjective criteria carefully. RESULTS After operation, 5 cases had total survival, 7 cases had peripheral or small area necrosis and 15 cases resulted in large area of necrosis. CONCLUSION: The conclusion was that if the incompletely avulsed skin showed sign of being compressed and squeezed, or the incompletely avulsed skin had uncertain or unstable circulatory status, even though the circulatory status being good, active attitude should be given to debridement in complete removal of the avulsed skin in order to improve the successful rate. For the other 2 cases with degloving injuries of large area of the limbs, the avulsed skin was made into a subdermal vascular network skin flap and several axial incisions were made to save the blood circulation of flap. The result was satisfactory and the vital tissues were preserved and used to the greatest extent.
In extensive frictionavulsion injuries, part of the injuried skin was still viable, so that total excision of the avulsed skin should be avoided. After debridememt, sutured the avulsed skin flap in situ temporarily and took a split-thickness graft from it. If bleeding occurred from the splitted surface of the dermis which was meant that part of the skin was alive. Along the border between the bleeding and nonbleeding area, the nonbleeding area of skin was excised. This could preserve the viable skin to the maximal extent. From July 1991 to May 1992, the viability of the skin in 8 avulsion injuries was judged. The maximal avul sed area was 13% and the minimal was 6% of the total body surface. After the treatment, 90% of the avulsed skin was alive. The appearance was satisfactory.