Hemostatik ajan Ankaferd kan durdurucunun uç-uca tek taraflı teleskobik balıkağzı anastomozlarda etkinliği

Öz

Amaç: Bu çalışmada, Ankaferd Kan Durdurucu (AKD) uygulamasıyla, tek taraflı uç-uca teleskobik balıkağzı anastomoz modelinde sütür sayısının azaltılması ve böylelikle anastomozun tamamlanma süresinin kısaltılmasının mümkün olup olmadığı gösterilmeye çalışılmıştır. Çalışma planı: Deneyde, 14 erkek Wistar albino sıçanın (ağırlık: 250-300 g) sağ ve sol femoral arterleri kullanılarak femoral arter uç uca tek taraflı balıkağzı anastomoz modeli oluşturuldu ve sıçanlar 2 gruba ayrıldı. A grubundaki sıçanlara AKD uygulanırken, B grubu kontrol grubunu teşkil etti. Sıçanlar daha sonra 2 alt gruba ayrıldı ve 7. günde Grup 1A ve 1B’deki, 14. günde ise Grup 2A ve 2B’deki anastomozlar eksplore edildi. Anastomozlar, süre, makroskobik ve mikroskobik patens, mikroanevrizma varlığı ve enflamatuar cevap açısından karşılaştırıldı. Bulgular: Ankaferd Kan Durdurucu uygulanan gruplarda (1A ve 2A) ortalama anastomoz süresi 13±1.50 dakika iken, kontrol gruplarında (1B ve 2B) 18.56±2.5 olarak ölçüldü. Aradaki farkın istatistiksel açıdan anlamlı olduğu gözlendi (p=0.001). Çıkarımlar: Ankaferd Kan Durdurucu, küçük çaplı ve düşük kan akımı hızı olan arterlerde gerçekleştirilecek arter-artere anastomozlarda, sütür sayısını ve anastomozun tamamlanma süresini azaltmada kullanılabilir.

Anahtar Kelimeler

• Anastomoz süresi; Ankaferd Kan Durdurucu; balıkağzı teleskobik anastomoz.

The efficacy of the hemostatic agent Ankaferd blood stopper on end-to-end unilateral sleeve fish-mouth anastomosis

Abstract

Objective: The aim of this study was to examine if the application of Ankaferd Blood Stopper (ABS) reduces the number of sutures and therefore reduces anastomosis completion time in a unilateral endto-end sleeve fish-mouth anastomosis model.
Methods: Femoral artery end-to-end unilateral fish-mouth anastomosis models were created from the right and left femoral arteries of 14 male Wistar albino rats (weight: 250 to 300 grams) and divided into 2 equal groups. Rats in Group A received ABS and Group B was the control group. Rats were further divided into equal 2 subgroups, and anastomoses of rats in Group 1A and 1B were explored on the 7th day and on the 14th day in Group 2A and 2B. The groups were compared for anastomosis completion time, macroscopic and microscopic patency, existence of microaneurysm and inflammatory response.
Results: In the ABS group (1A and 2A), mean anastomosis completion time was 13:00±1.50 minutes, and 18:56±2.5 minutes in the control groups (1B and 2B). This difference was statistically significant (p=0.001).
Conclusion: Ankaferd Blood Stopper may be used to reduce the number of sutures and shorten the completion time of artery-to-artery anastomosis of arteries with small diameter and low blood flow rate.

Keywords

• Anastomosis time
• Ankaferd Blood Stopper
• fish-mouth sleeve anastomosis

References

1. Acland RD. Microsurgery practice manual. Chapter 2, St. Louis: Mosby; 1980. p. 12-6.
2. Adams WP Jr, Ansari MS, Hay MT, Tan J, Robinson JB Jr, Friedman RM, et al. Patency of different arterial and venous end-to-side microanastomosis techniques in a rat model. Plast Reconstr Surg 2000;105:156-61.
3. Wei FC, Celik N. Perforator flap entity. Clin Plast Surg 2003;30:325-9.
4. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004;114:910-6.
5. Baxter TJ, O’Brien BM, Henderson PN, Bennett RC. The histopathology of small vessels following microvascular repair. Br J Surg 1972;59:617-22.
6. Gelderman PW, Berendsen W. Re-endothelialization of microvascular carotid end-to-side anastomosis in the rat. J Neurosurg 1979;51:785-95.
7. Little JR, Salerno TA. Continuous suturing for mi- crovascular anastomosis. Technical note. J Neurosurg 1978;48:1042-5.
8. Karl P, Tilgner A, Heiner H. A new adhesive technique for microvascular anastomoses: a preliminary report. Br J Plast Surg 1981;34:61-3.

9. Weis-Fogh US. Fibrinogen prepared from small blood samples for autologous use in a tissue adhesive system. Eur Surg Res 1988;20:381-9.
10. Beauchamp PJ, Guzick DS, Held B, Schmidt WA. His- tologic response to microsuture materials. J Reprod Med 1988;33:615-23.
11. Urbaniak JR, Soucacos PN, Adelaar RS, Bright DS, Whitehurst LA. Experimental evaluation of microsurgi- cal techniques in small artery anastomoses. Orthop Clin North Am 1977;8:249-63.
12. Morrison AD, Berwick L, Orci L, Winegrad AI. Morphol- ogy and metabolism of an aortic intima-media preparation in which an intact endothelium is preserved. J Clin Invest 1976;57:650-60.
13. Pratt GF, Rozen WM, Westwood A, Hancock A, Chubb D, Ashton MW, et al. Technology-assisted and sutureless microvascular anastomoses: evidence for current tech- niques. Microsurgery 2012;32:68-76.
14. Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Ak- man U, Ozturk Y, et al. Haemostatic actions of the folk- loric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008;36:163-70.
15. Haznedaroglu BZ, Haznedaroglu IC, Walker SL, Bilgili H, Goker H, Kosar A, et al. Ultrastructural and morpho- logical analyses of the in vitro and in vivo hemostatic ef- fects of Ankaferd Blood Stopper. Clin Appl Thromb He- most 2010;16:446-53.
16. Iynen I, Bozkus F, San I, Alatas N. The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy. Int J Pedi- atr Otorhinolaryngol 2011;75:1292-5.
17. Huri E, Haznedaroglu IC, Akgul T, Astarci M, Ustun H, Germiyanoulu C. Biphasic effects of ankaferd blood stop- per on renal tubular apoptosis in the rat partial nephrec- tomy model representing distinct levels of hemorrhage. Saudi Med J 2010;31:864-8.
18. Teker AM, Korkut AY, Gedikli O, Kahya V. Prospective, controlled clinical trial of Ankaferd Blood Stopper in chil- dren undergoing tonsillectomy. Int J Pediatr Otorhinolar- yngol 2009;73:1742-5.
19. Cipil HS, Kosar A, Kaya A, Uz B, Haznedaroglu IC, Gok- er H, et al. In vivo hemostatic effect of the medicinal plant extract Ankaferd Blood Stopper in rats pretreated with warfarin. Clin Appl Thromb Hemost 2009;15:270-6.
20. Sagi A, Yu HL, Ferder M, Gordon MJ, Strauch B. “No su- ture” microanastomosis using Vicryl rings and fibrin adhe- sive system: an unsuccessful attempt. Plast Reconstr Surg 1987;79:776-7.
21. Bowen CV, Leach DH, Crosby NL, Reynolds R. Micro- vascular anastomoses. A comparative study of fibrinogen adhesive and interrupted suture techniques. Plast Recon- str Surg 1996;97:792-800.
22. Padubidri AN, Browne E, Kononov A. Fibrin glue-assist- ed end-to-side anastomosis of rat femoral vessels: com- parison with conventional suture method. Ann Plast Surg 1996;37:41-7.