Koray GÜRSOY, Gökhan KOCA, Murat ALIŞIK, Nihat YUMUŞAK, Meliha KORKMAZ, Uğur KOÇER

Konsantre büyüme faktörünün random patern cilt flep yaşayabilirliği üzerine etkisi: deneysel çalışma

Giriş: Plastik ve rekonstrüktif cerrahide, random patern cilt flepleri çeşitli nedenlerle oluşan doku defektlerinin onarımında sıklıkla kullanılmaktadır. Bu tür fleplerde en sık karşılaşılan sorun yetersiz kan akımına bağlı flep distalinde görülen iskemik nekrozdur. Flep kayıplarını ortadan kaldırmak ve azaltmak için çok sayıda teknik tanımlanmıştır. Bu çalışmadaki amacımız tam kandan elde edilen ve büyüme faktörleri açısından zengin olan konsantre büyüme faktörünün (CGF) daha önce çalışılmamış olan random patern cilt flep yaşayabilirliği üzerine etkisini incelemektir. Gereç ve Yöntem: Çalışmada 50 adet Spraque –Dawley cinsi sıçan kullanıldı. Sıçanların 40 tanesi deney için, 10 tanesi CGF elde etmek için kullanıldı. Sıçanların sırt bölgelerinden kaldırılan 3x9 cm’lik distal bazlı McFarlene fleplerinin altına çalışma grubunda (n:20) CGF matriks yerleştirildi. Kontrol grubunda (n:20) herhangi bir tedavi uygulanmadı. İşlem sonrası 7. günde değerlendirme için fotoğrafik, sintigrafik ve histopatolojik inceleme yapıldı. Bulgular: Alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %53 (47-58) olarak bulundu. CGF uygulanan grupta ise flep viabilite ortanca oranı %58 (55-64) olarak bulundu. CGF grubunda elde edilen yüksek flep yaşayabilirlik oranları istatistiksel olarak anlamlı bulundu (p<0,001). Sintigrafik perfüzyon alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %54 (51-60) iken bu değer CGF uygulanan grupta %61 (59-64)’di. Elde edilen artış istatistiksel olarak anlamlı bulundu (p=0,001). Histopatolojik değerlendirme sonucunda çalışma grubunda elde edilen vaskülarite skorlarının ortanca değerlerinin (10,0 (8,25-11,75)) kontrol grubuna (7,5(6,25-9,00)) göre fazla olduğu görüldü ve bu fark istatistiksel olarak anlamlı bulundu (p=0,003). İnflamasyon skorları açısından gruplar arasında anlamlı farklılık saptanmadı (p=0,246). Sonuç: Bu çalışmanın sonuçları lokal olarak flep altına uygulanan konsantre büyüme faktörünün flep yaşayabilirliğini artırdığını ve bu etkinin anjiogenez ile ilişkili olabileceği gösterilmiştir ancak bu konuda ileri çalışmalara ihtiyaç vardır. Flep cerrahisinde, iskemi öngörülen durumlarda büyüme faktörlerinden zengin CGF’in uygulanmasının flep yaşayabilirliği üzerine olumlu etkileri olacaktır.

Anahtar Kelimeler:

Konsantre Büyüme Faktörü, CGF, Cilt Flebi, Flep Yaşayabilirliği

Effect of concentrated growth factor on random pattern skin flap viability: experimental study

Introduction: Random pattern skin flaps are used frequently for the reconstruction of random patern skin defects from various causes in plastic and reconstructive surgery. Most frequent complication with these flaps is the necrosis of distal parts due to inadequate blood supply. Various types of techniques have been defined to avoid and reduce flap loss. The aim of this study is to first time evaluate the effect of concentrate growth factor (CGF), which is derived from whole blood and is rich in growth factors, on the survival of random pattern skin flaps. Material and Method: Fifty Sprague-Dawley rats were used for the study. Forty of them were used for the experiment group and ten for the preparation of CGF. Distal based 3x9 cm Mcfarlene flaps were elevated from the back of the rats and in CGF group (n:20), CGF matrix was placed before closure. The control group (n:20) did not get any treatment. On postoperative day 7, the flaps were evaluated by photographic, scintigraphic, and histopathological methods. Results: The median rate of surviving flap areas in control group was 53% (47-58). In CGF group the median rate of flap viability was %58 (55-64). The higher flap viability rates obtained from CGF applied group was found to be statistically significantly higher from control group (p<0,001). For the scintigraphic perfusion area evaluations, the median rate of flap perfusion was 54% (51-60) for the control group and 61% (59-64) for the CGF group. The higher flap perfusion rates obtained from CGF applied group was found to be statistically significantly higher from control group (p=0,001). The median rate of vascularity scores in CGF treated group was 10,0 (8,25-11,75) and 7,5(6,25-9,00) in control group. The difference was found to be statistically significantly higher in the study group (p=0,003). Inflammation scores were not found to be statistically significantly different (p=0,246). Conclusions: This study shows that locally applied CGF under skin flap increases flap viability which might be associated with the increase in angiogenesis. This study for the first time shows that in flap surgery, applying CGF which is rich in growth factors, might have favourable effects on the flaps that are prone to ischemia but further studies are needed.

Keywords:

Concentrated Growth Factor, CGF, Skin Flap, Flap Viability,

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