Pediküllü fleplerdeki skarların flep yaşamına etkileri

Amaç: Skar, doku bütünlüğünün bozulması sonucu yara iyileşme mekanizmalarının devreye girmesiyle meydana gelen ve oluştuğu bölgede kan akımını olumsuz etkileyen bir patolojidir. Bu çalışmada diğer flep seçeneklerinin başvurulmasına sebep olan, flep planlanacak bölgedeki skarların olumsuz etkilerini ve skarın yönünün değişmesiyle ne gibi farklılıklar olacağı araştırıldı. Gereç ve yöntem: Çalışmada 24 adet Wistar Albino cinsi dişi rat kullanıldı. Ratların sırt bölgesinde ortadaki 1cm lik sağlam deri adasının her iki tarafında 2x6cm lik kaudal tabanlı flepler planlandı. İlk 12 ratta transvers skar içeren sol flep transvers skar grubu ve skar içermeyen sağ flep kontrol grubu olarak değerlendirildi. Diğer 12 ratta oblik skar içeren sol flep oblik skar grubu ve skar içermeyen sağ flep kontrol grubu olarak değerlendirildi. Flep araştırması için oluşturulan gruplar 1. Grup kontrol grubu (n=24) 2. Grup transvers skar grubu (n=12) 3. Grup oblik skar grubu (n=12) olarak adlandırıldılar. Sol flep pedikülünde transvers ve oblik skar oluşturulmasını takiben 30. günde kontrol grubunu oluşturan sağ flepler ile çalışma grubunu oluşturan sol flepler eleve edildi ve kaldırıldıkları bölgeye sütüre edildi. 4. günün sonunda ratlara eter ile anestezi ve ötenazi uygulandı. Her iki tarafta canlı kalan flep alanları milimetrik olarak ölçüldü. Skarıda içine alacak şekilde histopatolojik inceleme için çalışma ve kontrol fleplerinden biyopsiler alındı. Bulgular: Her bir flebin toplam alanı 1200mm2 ve 1000mm2 dir. Transvers skar içeren ratlarda skarlı fleplerde nekroz olan flep alanı ortalaması % 80,8 iken skarsız fleplerde bu oran % 57,6 olarak bulundu. Oblik skar içeren ratlarda skar grubunda nekroza uğrayan flep alanı ortalaması % 83.9 iken skarsız kontrol grubunda % 63,3 tür. Histopatolojik bulgu olarak skarsız kontrol grubunda normal yapıda epidermis ve dermiş komponentleri görülürken her iki skar grubunda da epidermis ve dermiste atrofi, adneksiyal yapıların kaybı, retiküler dermisi tutan fibrozis görüldü. Sonuç: Skar random flep canlılığını olumsuz yönde etkileyen bir faktördür. Skar yönü nekroz oranını değiştirmemiştir. Skar distalinde kalan bir deri flebinin normalde yaşaması gereken kısmının ancak yarısının yaşayabileceği sonucuna varılmıştır. Purpose: Scar is a pathology that occurs when the wound healing mechanisms take action as a result of the deterioration of tissue integrity and that adversely a!ects the blood flow in the region where it occurs. In this study, we investigated the negative effects of the exisiting scars in the area of scheduled flap, which led to the consideration of other flap options, and investigated the differences that would arise with the change of the direction of the scar. Materials and Methods: Twenty-four female Wistar Albino rats were used in the study. In the back region of the rats, a 2x6cm caudal-based flaps were planned on both sides of a 1 cm intact skin island. In the first 12 rats, the left flaps with transverse scar were included in the Group with transverse scar, and the right flaps without scar were included in the control group. In the other 12 rats, the left flaps with an oblique scar were included in the Group with oblique scar and the right flaps without scar were included in the control group. The groups created for flap investigation were named as follows: Group 1: The control group (n=24) Group 2: The group with transverse scar (n=12) Group 3: The group with oblique scar (n=12) Following transverse and oblique scar formation in the left flap pedicle, the right flaps forming the control group and the left flaps forming the study group were elevated on the 30th day, and they were sutured in the site where they were elevated. At the end of the 4th day, rats were anesthetized with ether and euthanized. The surviving flap areas on both sides were measured in millimeters. Biopsies including the scars were taken from the study and control flaps for histopathological examination. Results: The total area of each flap was 1200 mm2 and 1000mm2. While the mean flap area with necrosis in scarred flaps was 80.8% in the rats with transverse scars, this ratio was found as 57.6% in scarless flaps. In the rats with oblique scar, the mean flap area with necrosis was 83.9% in the scar group whereas it was 63.3% in scarless control group. As histopathological findings; while epidermis and dermis components in normal structure were seen in the scarless control group, atrophy in epidermis and dermis, loss of adnexal structures, and fibrosis involving reticular dermis were seen in both scar groups.

Anahtar Kelimeler:

flep, nekroz, pedikül, skar

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