Dört farklı dermal dolgu maddesinin neden olduğu damar tıkanıklığı sonrasında histopatolojik bulgular ve flep sağ kalımının karşılaştırılması.

Year 2025, Volume: 35 Issue: 1, 203 - 211, 28.02.2025

Ömer Buhsem , Ahmet Koyuncu , Pembe Oltulu , Mouth Zuhour , Bilsev İnce

https://doi.org/10.54005/geneltip.1620024

Abstract

Amaç: Bu deneysel çalışma, intraarteriyel dermal dolgu maddeleri kalsiyum hidroksilapatit, polikaprolakton, agaroz jel, hyaluronik asit ve serum fizyolojik enjeksiyonu ile oluşan vasküler oklüzyona bağlı hasar, histopatolojik bulgular ve flep nekroz oranlarını karşılaştırmalı olarak değerlendirmek için tasarlanmıştır.
Materyal ve Yöntemler: Çalışma 120 fare kullanılarak yürütüldü, 120 fareden 100'ü 5 gruba ayrıldı, her iki taraftaki inferior epigastrik arterlere 4 farklı dermal dolgu maddesi ve serum fizyolojikten 0,02 ml enjekte edildi, her grupta 40 arter kullanıldı. Her grup için 0. saatte, 1. saatte, 3. saatte, 24. saatte ve 1. haftada histopatolojik inceleme için 8 damardan örnek alındı. Damarların intima ve media tabakalarında dejenerasyon-nekroz, inflamasyon, fibroblast ve kollajen yoğunlukları, damarlarda trombüs varlığı, ödem varlığı, PMNL, lenfosit, mast hücresi, makrofaj ve eozinofil yüzdeleri ve kalsifikasyon varlığı değerlendirildi. Geriye kalan 20 fare, inferior epigastrik arterler tarafından beslenen her iki tarafta oluşturulan 40 flep de arter oklüzyonu oluşturmak için 5 farklı enjeksiyon grubuna ayrıldı ve enjeksiyondan 1 hafta sonra flep nekroz oranlarının değerlendirilmesinde kullanıldı.
Sonuçlar:
Gruplar arasında flep nekroz yüzdesi değerinde istatistiksel olarak anlamlı bir fark vardı. Post-HOC, farkın daha yüksek nekroz yüzdesine sahip HA grubundan kaynaklandığını gösterdi. Tüm lümeni dolduran trombüsün HA grubunda diğer gruplara göre tüm saatlerde ve ilk haftada daha yüksek olduğu görüldü. İntima ve medya dejenerasyonları incelendiğinde tüm zamanlarda ve tüm gruplarda istatistiksel olarak anlamlı bir fark ve PMNL, lenfosit, mast ve makrofaj dağılımı incelendiğinde belirli zamanlarda anlamlı bir fark vardı. Eozinofil ölçümü, inflamasyon, fibroblast yoğunlukları ve kollajen yoğunlukları, ödem ve kalsifikasyon bulguları değerlendirildiğinde gruplar arasında anlamlı bir fark bulunmadı
Sonuç:
Her bir dolgu maddesi arasında arter içinde istatistiksel olarak anlamlı histopatolojik farklılıkların yanı sıra, özellikle hyaluronik asit grubunun lümeni tamamen tıkayan trombüse diğer gruplardan anlamlı olarak daha fazla neden olduğu ve buna bağlı olarak flep nekroz oranının HA dolgusu olmayan gruplara göre anlamlı olarak daha yüksek olduğu sonucuna varıldı. Bu sonuç, özellikle hyaluronik asit dolgularında antitrombotik ve trombolitik tedavinin önemini vurguladı.

Keywords

vasküler oklüzyon, kalsiyum hidroksiapatit, polikaprolakton; hyaluronik asit., agaroz jel

Comparison of histopathological findings and flap survival following 4 different dermal filler material induced vascular occlusion.

Abstract

Aim: This experimental study was designed to comparatively evaluate the damage, histopathological findings and flap necrosis rates due to vascular occlusion caused by intraarterial injection of dermal fillers calcium hydroxylapatite, polycaprolactone, agarose gel, hyaluronic acid and serum physiologique.

Material and Methods: Study was conducted using 120 rats, 100 of 120 rats were divided into 5 groups, 0.02 ml of 4 different dermal fillers and serum physiologique were injected into the both side inferior epigastric arteries, 40 arteries were used in each group. For each group, samples taken from 8 vessels for histopathological examination at 0 hour, 1 hour, at 3 hours, at 24 hours, and at 1 week. Degeneration-necrosis, inflammation, fibroblast and collagen densities in the intima and media layers of the vessels, the presence of thrombus in the vessels, the presence of edema, PMNL, lymphocyte, mast cell, macrophage and eosinophil percentages and the presence of calcification were evaluated. The remaining 20 rats, 40 flaps created in both sides nourished by the inferior epigastric arteries were also divided into 5 different injection groups to create artery occlusion and used for the evaluation of flap necrosis rates 1 week after injection .

Results:
There was a statistically significant difference in percentage of flap necrosis value between the groups. Post-HOC showed that the difference was due to the HA group which has higher necrosis percentage. It was observed that thrombus filling the whole lumen was higher in the HA group compared to the other groups at all hours and in the first week. When intima and media degenerations, were examined there was a statistically significant difference at all times and in all groups and significant difference at certain times when examine distribution of PMNL, lymphocyte, mast, and macrophage. When eosinophil measurement, inflammation, fibroblast densities and collagen densities, edema and calcification findings were evaluated, no significant difference was found between the groups

Conclusion:
It was concluded that besides statistically significant histopathological differences between each fillers within the artery, in particular, the hyaluronic acid group caused thrombus, which completely occluded the lumen, significantly more than the other groups, and accordingly, the flap necrosis rate was significantly higher than the non-HA filler groups. This result highlighted the importance of antithrombotic and thrombolytic therapy especially in hyaluronic acid fillers.

Keywords

vascular occlusion, calcium hydroxylapatite, agarose gel, polycaprolactone; hyaluronic acid.

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