Aylin AKBULUT, Koray GURSOY, Nihat YUMUSAK, Gokhan KOCA, Meliha KORKMAZ

Deneysel sıçan modelinde iskemiye bağlı deri flep nekrozunda hemostatik ajan kullanım

Amaç: Operasyon alanlarında hemostazı elde etmek için bitki bazlı hemostatik ajanların kullanımı artmaktadır. Ancak bu ajanların vasküler kanlanmanın önemli olduğu durumlarda kullanımı ile ilgili herhangi çalışma bulunmamaktadır. Kullanımı son yıllarda yaygınlaşan, bitki bazlı bir topikal hemostatik ajan olan Ankaferd’in (ABS) McFarlane flep viyabilitesi üzerindeki etkisini sıçan modelinde inceledik. Gereç ve Yöntemler: Yirmi sıçanda McFarlane tarzı flepler genel anestezi altında eleve edildi. Sıçanların 10’u Grup I olarak atandı ve başka ek tedavi uygulanmadı. Grup II'deki 10 sıçanın fleplerinin alt yüzlerine ABS uygulandı. Flepler orijinal yerlerine adapte edildikten sonraki 7. günde flap viabilitesi için sintigrafik çekim ve dijital olarak çekilen fotoğraflarla topografik analiz yapıldı. Canlı flep alanları sintigrafik görüntülerde belirlendi ve bu alanların pikselleri total flep alanına oranlandı. Sonrasında flep dokuları histopatolojik olarak değerlendirildi. Bulgular: Sintigrafik analizde, Grup I ile karşılaştırıldığında, Grup II’de flepin proksimal sap kesiminde sınırlı alanda viyabilite gözlendi ve flep viyabilitesi yüzdesi Grup I ve Grup II için sırasıyla, %56.33±9.94, %26.27±7.05 olarak bulundu. Grup II’de gözlenen nekrotik doku yüzdesi Grup I’e oranla anlamlı olarak yüksekti (p <0.001). Aynı şekilde makroskopik gözlemle uyumlu olarak ABS ile tedavi edilen sıçanlar kontrol grubu ile karşılaştırıldığında, topografik analizinde bulunan canlı doku alanı anlamlı olarak daha küçüktü (%26.81±5.55, karşın %59.66±12.04, p<0.001). Benzer şekilde histopatolojik sonuçlarda, ABS grubunda kontrol grubuyla karşılaştırıldığında histopatolojik değişikliklerde anlamlı artış (p <0.001), neovaskülarizasyonda anlamlı azalma saptandı (p <0.001). Sonuç: Çalışmamızın sonucunda cerrahi hemostazdaki etkinliğine rağmen, ABS kullanımının özellikle cilt flepleri gibi marjinal olarak perfüze dokularda flep viyabilitesine olumsuz etkisi bulunmuştur. Dolayısıyla, vasküler damarlanmanın önemli olduğu dokularda ABS kullanımında dikkatli olunmalıdır

Anahtar Kelimeler:

Flep Canlılığı; Ankaferd; ABS (Ankaferd Blood Stopper); Hemostatik Ajan

Results of a hemostatic agent to potentiate ischemia-induced skin flap necrosis in an experimental rat model

Aim: The uses of plant based hemostatic agents are increasing for obtaining operative field hemostasis. However, their effects on vascularly challenged tissue is not known. The aim of this study was to investigate the effect, if any, of plant-based hemostatic agent, Ankaferd (ABS) on flap viability in a rat model. Material and Methods: Twenty rats underwent McFarlane flaps under general anesthesia. Ten rats in Group I received no other treatment. Ten rats in Group II received ABS to the underside of flaps. Viable flap area was determined in scintigraphic images and percentage of viable flap area pixel size to the total flap area pixel size was calculated. Additionally all flap areas were digitally photographed and underwent histopathologic evaluation. Results: Scintigraphic analysis has shown limited viability at proximal pedicle zone of flap in Group II compared to Group I. The mean area of flap survival percentage was calculated in Group I and in Group II was as follows respectively 56.33 ±9.94%, 26.27±7.05%. Differences between groups were statistically significant (p<0.001). Similarly, Group II has shown significantly smaller area of viable tissue percentage compared to Group I (26.81±5.55%, versus 59.66±12.04%, p<0.001) by digital photographic analysis. Histopathologic results were significantly high in Group II compared to Group I (p<0.001) whereas neovascularization was significantly low in Group II compared to Group I (p<0.001). Conclusion: Despite its efficacy in surgical hemostasis, ABS use is associated with an increased incidence of distal tip necrosis in dorsal rat skin flaps. Therefore ABS use in marginally perfused tissues particularly in random skin flaps should be cautious.

Keywords:

Flap Viability; Ankaferd; ABS (Ankaferd Blood Stopper); Hemostatic Agent,

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