Özgen KIVANÇ, Mirza YILDIRIM, Yeliz ARMAN KARAKAYA, Makbule Gülbin Erdem KARAHANOĞLU, Erkan KURAL, Barış ALTAYLI

Otolog kıkırdak greftinin cerrahi prp ve fasya ile kombinasyonun histopatolojik etkileri

Amaç:Rinoplasti sonrası oluşan “nazal dorsum düzensizlilikleri”, cerrahlar ve hastalar tarafından istenmeyen bir durumdur. Bu tablonun çözümü üzerinde tedaviye yönelik oldukça geniş kapsamda protokol tanımlanmış olmakla birlikte, henüz bir altın standart oluşturulamamıştır. Nazal dorsum düzensizliklerinin düzeltilmesinde en çok tercih edilen seçenek, otolog kıkırdak greftleridir. Bu deneysel çalışmada, otolog kıkırdak greftinin surgicell prp ve fasya ile kombinasyonun erken dönem histopatolojik etkileri incelenmiştir. Gereç ve yöntem: Bu çalışmada, 10 adet Spraque-Dawley Albino cinsi erkek sıçan denek olarak kullanılanılmıştır. Sıçanların her iki kulağından kıkırdak greftleri alınarak, sırtta yüzeyel fasya altında oluşturulan dört adet poşa yerleştirildi. Kontrol grubunda kıkırdak herhangi bir maddeye sarılmadan; diğer üç 3 grubunda ise, surgicell, fasya ve prp (trombositten zengin plazma) jelle sarılarak yerleştirildi. Onuncu gün sonunda, kıkırdaklardan biyopsiler yapılarak histopatolojik inceleme yapıldı. Tüm sıçanlar sakrifiye edildi. Bulgular: Yapılan histopatolojik inceleme sonucunda; surgicell ve fasyayla sarılan kıkırdakların viabilitesinin olumsuz yönde etkilendiği, prp jele sarılan kıkırdaklarda ise, olumlu veya olumsuz bir etkinin olmadığı gözlenmiştir. Sonuç: Nazal augmentasyon için kullanılan kıkırdak greftlerinin surgicell, fasya ile sarılarak yerleştirilmesinin greft yaşayabilirliğini olumsuz etkilediği, prp jel ile sarılmasının greft yaşayabilirliğine olumlu veya olumsuz herhangi bir etkisinin olmadığı görüldü.

Histopathological effects of autologous cartilage graft combination with surgical prp and fascia

Purpose: Nasal dorsal irregularities are undesired situations in rhinoplasty. Although a wide range of treatment protocols have been described to solve this problem, gold standard treatment has not been described yet. The most preferred option for the correction of nasal dorsum irregularities are otolog cartilage grafts. Early histopathological effects of autologous cartilage graft combination with surgicell prp gel and fascia were analyzed in this experimental study. Material and method: In this study, 10 Spraque-Dawley Albino male rats were used as subjects. Cartilage grafts were harvested from both ears and placed in four pouches formed under the superficial fascia on the back. In control group, cartilage placed alone and in treatment groups; before placing, cartilages wrapped with surgicell, prp (platelet rich plasma) gel and fascia. At 10th day, biopsies were taken from all cartilages to do the histopathological examination. All rats were sacrificed. Results: As a result of histopathological examination; It was observed that the viability of cartilage wrapped with surgicell and fascia was negatively affected, whereas cartilage wrapped with prp gel did not have a positive or negative effect. Conclusion: Wrapping the cartilage grafts with surgicell and fascia have negatively effect on graft viability whereas wrapping with prp gel hasn’t any effect on graft viability in nasal dorsum augmentation.

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1. Trivisonno A, Cohen SR, Magalon G, et al. Fluid cartilage as new autologous biomaterial in the treatment of minor nose defects: clinical and microscopic difference amongst diced, crushed, and fluid cartilage. Materials 2019;12:10632. https://doi/10.3390/ma12071062
2. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 2000;105:2229-2241. https://doi.org/10.1097/00006534-200005000-00051
3. Guerrerosantos J, Trabanino C, Guerrerosantos F. Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty. Plast Reconstr Surg 2006;117:804-812. https://doi.org/10.1097/01. prs.0000200068.73092.5d
4. Calvert JW, Brenner K, DaCosta Iyer M, Evans GR, Daniel RK. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg 2006;118:230-236. https://doi.org/10.1097/01.prs.0000220463.73865.78
5. Cerkes N, Basaran K. Diced cartilage grafts wrapped in rectus abdominis fascia for nasal dorsum augmentation. Plast Reconstr Surg 2016;137:43-51. https://doi.org/10.1097/PRS.0000000000001876
6. Sermer C, Devitt B, Chahal J, Kandel R, Theodoropoulos J. The addition of platelet-rich plasma to scaffolds used for cartilage repair: a review of human and animal studies. Arthroscopy 2015;31:1607-1625. https://doi. org/10.1016/j.arthro.2015.01.027
7. Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004;91:4- 15. https://doi.org/10.1160/TH03-07-0440
8. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004;114:1502-1508. https://doi.org/10.1097/01. prs.0000138251.07040.51
9. Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesth Plast Surg 2011;35:569-579. https://doi.org/10.1007/s00266-011- 9725-9
10. Fortier LA, McCarrel TM, Sundman EA, et al. Biologic therapy for joint disease platelet-rich plasma, interleukin-1 receptor antagonist protein/autologous condition serum, and bone marrow aspirate AAEP PROCEEDINGS 2011;57:115-117. Available at: https://www.researchgate.net/publication/285767892. Accessed January 2011
11. Liu Z, Yuan X, Fernandes G, et al. The combination of nano-calcium sulfate/ platelet rich plasma gel scaffold with BMP2 gene-modified mesenchymal stem cells promotes bone regeneration in rat criticalsized calvarial defects. Stem Cell Research Therapy 2017;8:122. https://doi.org/10.1186/s13287-017-0574-6
12. Sun Y, Feng Y, Zhang CQ, Chen SB, Cheng XG. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects International Orthopaedics 2010;34:589-597. https://doi.org/10.1007/s00264-009- 0793-2
13. Topkara A, Özkan A, Özcan RH, Öksüz M, Akbulut M. Effect of concentrated growth factor on survival of diced cartilage graft Aesthetic Surg J 2016;36:1176- 1187. https://doi.org/10.1093/asj/sjw137
14. Hizal E, Buyuklu F, Özer Ö, Çakmak O. Effects of different levels of crushing on the viability of rabbit costal and nasal septal cartilages. Plastic and Reconstructive Surgery 2011;128:1045-1051. https://doi.org/10.1097/ PRS.0b013e31822b6651