İSA ÖZAYDIN, Emine ÜNSALDI, Özgür AKSOY, SADIK YAYLA, Miktat KAYA, Muzaffer Başak TUNALI ULKAY, ABİT AKTAŞ, Erol TAŞDEMİROĞLU, Mete CİHAN, BAŞAK KURT, Hakan Can YILDIRIM, Ahmet ŞENGÖZ, Hakan ERDOĞAN

The effect of silicone tube and silicone tube + hyaluronic acid application on adhesion formation in experimental peri- and epi-neurorrhaphy in A rat model

Bu çalışmada deneysel siyatik sinir kesisi oluşturulan Wistar albino ratlarda nörorafiyi izleyerek, ilgili alana sadece silikon tüp (ST) ve ST ile birlikte hyaluronik asit (HA) uygulamasının fibrozisi engellemedeki etkinliği klinik ve histopatolojik olarak incelendi. Siyatik sinirde total kesi oluşturulduktan sonra interfasiküler ve epinöral anastomoz uygulandı. Birinci grupta (Kontrol Grubu) sadece anostomoz yapılırken, ikinci grubta (ST Grubu) anastomoz + silikon tüp, üçüncü grubta ise (ST + HA Grubu) anastomoz + silikon tüp + Hyaluronik asit (HA) uygulandı. Her bir gruptaki hayvanlar 2 alt gruba ayrılarak postoperatif 30 ve 60. günlerde makroskopik ve histopatolojik incelemeler yapıldı. Çalışmanın 30. gününde tüm hayvanların yürüyüşleri problemliydi. 60. günde ST ve ST + HA grubundaki hayvanlarda yürüyüş normal iken kontrol grubunda problem devam etmekteydi. Prostmortem makroskopik bakıda 30 ve 60. günlerde kontrol grubunda sinir dokuda düzensiz bir morfoloji ve çevreye yapışıklık mevcuttu. ST Grubunda 60. günde daha belirgin olmak üzere tüp içerisinde anastomoz hattında skar doku ile karşılaşılırken ST + HA grubunda 30 ve 60. günlerde sinir anastomoz hattının pürüzsüz bir görünümde olduğu saptandı. Sonuç olarak, 30 günde ST ve ST + HA gruplarında miyelin kalınlığının azalması ve miyelin dejenerasyonun artması HA’in kısa dönemde akson rejenerasyonu için pozitif bir etki oluşturmadığını, buna karşın 60. günde ST ve ST + HA gruplarında aksonların miyelin kalınlığı ve akson alanlarının arttırmasıyla birlikte miyelin dejenerasyonun azalması, silikon tüp ve HA’in uzun dönemde miyelinizasyon üzerinde pozitif bir etki oluşturduğunu göstermiştir.

Deneysel peri ve epinöral nörorafi uygulanmış rat modellerinde silikon tüp ve silikon tüp + hyaluronik asit uygulamasının adezyon formasyonuna etkisi

Following neurorrhaphy in Wistar albino rats with experimental sciatic nerve cut, the effectiveness of solely silicone tube (ST) and ST plus hyaluronic acid application on preventing fibrosis was clinically and histopathologically examined. After a total nerve cut is created in sciatic nerve, interfascicular and epineural anastomosis was used. While only anastomosis was applied for the first group (Control Group), for the second group (ST Group) anastomosis + silicone tube and for the third group (ST + HA Group) anastomosis + silicone tube + hyaluronic acid (HA) were applied. Animals in each group were divided into 2 sub-groups and macroscopic and histopathological examinations were conducted on the 30th and 60th postoperative day. On day 30 of the study all the animals had problematic walks. On the 60th day while animals in groups ST and ST + HA were walking normally, the problem was still going on for the control group. In the postmortem macroscopic examinations performed in the control group on the 30th and 60th days an irregular morphology and adhesion to surrounding in nerve tissue were seen. Whereas in group ST, in the anastomosis line within the tube, scar tissue which was clearer on the 60th day was observed, in group ST + HA it was seen that nerve anastomosis line was smooth on the 30th and 60th days. As a consequence, the reduction in myelin thickness and the increase in degenerated myelin for groups ST and ST + HA in 30 day show that HA does not create a positive effect on axon regeneration in the short run, on the other hand, the reduction in myelin degenerated along with the increase of axon myelin thickness and axon cross section areas in groups ST and ST + HA in day 60 has shown that silicone tube and HA application creates a positive impact on myelination in the long run.

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