Ayse Özlem Gündeşlioğlu, İrfan İnan, Yılmaz Tezcan, Hatice Toy, Dilek Emlik, Murad AKTAN, Selçuk DUMAN

Trombositten Zengin Plazma ile Kombine Edilmiş Yağ Doku Kökenli Stromal Vasküler Fraksiyonun Silikon İmplantlar Çevresinde Radyasyonun İndüklediği Kapsül Kontraktürü Üzerine Etkileri

Kozmetik veya rekonstrüktif meme büyütme cerrahisi sonrası implant çevresinde gelişen kapsülün nedeni ve patogenezi henüz tam olarak bilinmemektedir. Bununla birlikte, son dönemde yapılan deneysel çalışmalar ve klinik gözlemler, yağ doku kökenli mezenkimal kök hücrelerin biyomateryaller çevresine uygulanmasının kapsül oluşumunu azalttığına dair olumlu ve cesaret verici sonuçlar ortaya koymuştur. Bu çalışmada, sırt bölgelerine mini silikon implant yerleştirilen ve radyasyon verilerek implantlar çevresinde kapsül oluşturulan ratlarda, trombositten zengin plazma ile kombine edilerek verilen yağ doku kökenli stromal vasküler fraksiyonun, kapsül oluşumu üzerine etkileri araştırıldı. Sırt bölgesinde her iki tarafa yerleştirilen silikon implant alanlarının tek fraksiyon 10 Gy elektron ile ışınlanmasını takiben, tüm ratların sadece sağ tarafta ki implant çevresine ve çevre dokulara trombositten zengin plazma ile kombine edilmiş yağ doku kökenli stromal vasküler fraksiyon uygulandı. Sol taraftaki implant çevresine ise kontrol grubu olmak üzere aynı miktarda serum fizyolojik enjekte edildi. Operasyon sonrası 30. günde implantların çevresinde gelişen kapsül kalınlıkları ultrasonografik, histopatolojik ve immunohistokimyasal olarak incelendi. Sonuçlar kapsül kalınlığı açısından tedavi uygulanan ve uygulanmayan taraflar arasında ultrasonografik, histopatolojik ve immunohistokimyasal değerlendirmelerde istatistiksel olarak anlamlı fark bulunmadığını gösterdi. Bu ön bulgular yağ doku kökenli kök hücre ve trombositten zengin plazma kombinasyonunun, silikon implant ile dokuların entegrasyonunun sağlanmasında ve implant çevresinde kapsül oluşumunu azaltmada etkinlikleri olmadığını ve yeni çalışmalara ihtiyaç olduğunu göstermiştir.

Anahtar Kelimeler:

Stromal vasküler fraksiyon, trombositten zengin plazma, kapsül, radyasyon

The Effect of Adipose Tissue Stromal Vascular Fraction Combined with Platelet-Rich Plasma on Irradiation-Induced Capsular Contracture Around Silicone Implants

The exact reason and pathogenesis of capsule formation around breast implant after cosmetic and reconstructive breast enhancement is still unclear. However, recent studies and clinical observations regarding the application of adipose-derived mesenchymal stem cells around implanted biomaterials have shown encouraging results. In this study, the effects of the adipose-derived stromal vascular fraction combined with platelet-rich plasma on capsule formation around silicone implants were investigated in irradiated rats. After implantation of silicones implants bilaterally on the rat dorsal area, both sides were irradiated with 10-Gy as single fraction electron beam irradiation. Following radiation, the mixture of stromal vascular fraction and platelet-rich plasma was injected to right sides of the animals. Left sides were injected with same amount of saline as a control. On day 30, capsule around the implants was evaluated in regarding the capsular thickness by ultrasonography, histopathology and immunohistochemical examination. The results demonstrated that there is no statistically significant difference between the treated and non-treated groups in ultrasonographic, histopathologic, and immunohistochemical evaluations. These preliminary results demonstrated that adipose-derived stem cells with platelet rich plasma do not have efficiency for integration of tissue and silicone implants and to reduce capsule formation and further studies are required

Keywords:

Stromal vascular fraction, platelet rich plasma, capsule, radiation,

PDF

___

American Society of Plastic and Reconstructive Surgeons. More 1.
Mastectomy Patients Opting for Breast Reconstruction. Arling
ton Heights, Ill: ASPRS; 1991.
Gabriel SE, Woods JE, O’Fallon WM, Beard CM, Kurland LT, Melton
LJ 3rd. Complications leading to surgery after breast implanta
tion. N Engl J Med. 1997; 336:677-82.
Kamel M, Protzner K, Fornasier V, Peters W, Smith D, Ibanez D.
The peri-implant breast capsule: An immunophenotypic study
of capsules taken at explantation surgery. J Biomed Mater Res. 2001;58:88-9.
Sieminski AL, Gooch KJ. Biomaterial-microvasculature interac- 4.
tions. Biomaterials. 2000;21:2233-41.
Anderson JM. Biological responses to materials. Annu Rev Mater 5.
Res. 2001;31:81-110.
Castner DG, Ratner BD. Biomedical surface science: Foundations 6.
to fronteries. Surf Sci. 2002;500:28-60.
Williams SK, Berman SS, Kleinert LB. Differential healing and 7.
neovascularization of ePTFE implants in subcutaneous versus
adipose tissue. J Biomed Mater Res. 1997;35:473-81.
Pichard HL, Reichert WM, Klitzman B. Adult adipose-derived 8.
stem cell attachment to biomaterials. Biomaterials. 2007;28:936- 56.
Suga H, Eto T, Shigeura K, Inoue H, et al. IFATS Collection: Fi- 9.
broblast growth factor-2-induced hepatocyte growth factor
secretion by adipose-derived stromal cells inhibits postinjury
fibrogenesis through a c-Jun N-terminal kinase-dependent
mechanism. Stem Cells. 2009;27:238-49. 10. Rigotti G, Marchi A, Galie M, et al. Clinical treatment of radiother
apy tissue damage by lipoaspirate transplant: A healing process
mediated by adipose-derived adult stem cells. Plast Reconstr
Surg. 2007;119:1409-22. 11. Montesaano R, Vasalli JD, Baird A, et al. Basic fibroblast growth
factor induces angiogenesis in vitro. Proc Natl Acad Sci USA.
;83:7297-301. 12. Plant-Berard V, Silvestre JS, Cousin B, et al. Plasticty of human
adipose lineage cells toward endothelial cells: Physiological and
therapeutic perspectives. Circulation. 2004;109:656-63. 13. Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: A review
of biology and applications in plastic Surgery. Plast Reconstr
Surg. 2006;118(6):147e-159e. 14. Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle
using platelet rich plasma. Clin Sports Med. 2009;28:113-25. 15. Kakudo N, Minakata T, Mitsui T, et al. Proliferation-promoting
effect of platelet-rich plasma on human adipose-derived
stem cells and human dermal fibroblast. Plast Reconstr Surg.
;122:1352-60. 16. Katzel EB, Koltz PF, Tierney R et al. The impact od Smad3 loss
of function on TGF_b signaling and radiation- induced capsular
contracture. Plast Recosntr Surg. 2011; 127. 2263-9. 17. Yoshimura K, Shigeura T, Matsumato D, et al. Characterization of
freshly isolated and cultured cells derived from the fatty and flu
id portions of liposuction aspirates. J Cell Physiol. 2006;208:64- 76. 23. Allen RJ Jr, Canizares O Jr, Scharf C, et al. Grading lipoaspirate:
Is there an optimal density for fat grafting? Plast Reconstr Surg.
; 131: 38-45. 24. Akbulut H, Cuce G, Aktan TM, Duman S. Expression of mesen
chymal stem cell markers of human adipose tissue surrounding
the vas deferens. Biomed Res. 2012; 23: 166-9. 25. Turesson I, Thames HD. Repair capacity and kinetics of human
skin during fractionated radiotherapy: erythema, desquama
tion, and telangiectasia after 3 and 5 year’s follow-up. Radiother
Oncol. 1989;15(2):169-88. 26. Hatfield A, Bodenham A. Ultrasound: an emerging role in anaes
thesia and intensive care. B J Anaesth 1999; 83: 789-800.
Geddes DT. The use of ultrasound to identify milk ejection in
women – tips and pitfalls. International Breast Feeding Journal 2009; 4: 5.
Amann P, Botta U, Montet X, Bianchi S. Sonographic Detection
and Localization of a Clinically Nondetectable Subcutaneous
Contraceptive Implant. J Ultrasound Med 2003; 22: 855–9.