THE EFFECT OF OZONE MEDIATED PRECONDITIONING ON FLAP VİABİLİTY IN RATS: AN EXPERİMENTAL STUDY

Abstract

Objectives: There are many type of preconditioning techniques in flap surgery. But ozone mediated preconditioning method was not studied sufficiently. The main purpose of our study is to show the effect of preoperative ozone gas on flap viability and to reveal that ozone therapy can be used as a preconditioning method in skin flaps. Methods: 40 rats were randomly divided into 4 groups and a caudal-based 11x3 cm modified Mac Farlane flap was elevated for all subjects. At the end of one week, back flaps were removed and evaluated macroscopically and histopathologically. Results: In terms of flap viability, all groups were statistically better than the control group not only macroscopically but also hystopathologically. Chronic inflammation scores, amount of granulation tissue and neovascularization were higher in all groups and especially in the preoperative ozone group compared to the control group (p <0.001). Conclusion: In our study, it has been shown that ozone mediated pretreatment method has both macroscopically increased flap survival and beneficial effects at histopathological level.

Keywords

• Skin flap
• ozone gas
• ozone mediated preconditioning
• rectal ozone therapy.

OZON ARACILI ÖN KOŞULLANDIRMANIN SIÇANLARDA FLEP YAŞAYABILIRLIĞI ÜZERINE ETKISI: DENEYSEL BIR ÇALIŞMA

Abstract

Giriş: Flep cerrahisinde birçok ön koşullandırma tekniği vardır. Ancak ozon aracılı ön koşullandırma yöntemi yeterince çalışılmamıştır. Çalışmamızın temel amacı, ameliyat öncesi ozon gazının flep canlılığı üzerindeki etkisini göstermek ve cilt fleplerinde ozon tedavisinin bir ön koşullandırma yöntemi olarak kullanılabileceğini ortaya koymaktır. Metot: 40 adet sıçan rastgele 4 gruba ayrıldı ve tüm deneklere kaudal tabanlı 11x3 cm modifiye Mac Farlane flebi kaldırıldı. Bir hafta sonunda sırt flepleri çıkarılarak makroskopik ve histopatolojik olarak değerlendirildi. Bulgular: Flep canlılığı açısından, tüm gruplar sadece makroskopik olarak değil aynı zamanda histopatolojik olarak da kontrol grubuna göre istatistiksel olarak daha iyiydi. Kronik inflamasyon skorları, granülasyon dokusu miktarı ve neovaskülarizasyon tüm gruplarda ve özellikle preoperatif ozon grubunda kontrol grubuna göre daha yüksekti (p<0,001). Sonuç: Çalışmamızda ozon aracılı ön tedavi yönteminin hem makroskopik olarak flep sağkalımını arttırdığı hem de histopatolojik düzeyde faydalı etkileri olduğu gösterilmiştir.

Keywords

• Cilt flep
• ozon gazı
• ozon aracılı ön koşullandırma
• rektal ozon tedavisi.

References

1. Referans 1 Ince B, Daaci M, Altuntas Z, Sodali T, Bilgen F, Evrenos MK. Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients. Annals of Saudi medicine. 2014;34(3):235-40.
2. Referans 2 Harder Y, Amon M, Laschke M, Schramm R, Rücker M, Wettstein R, et al. An old dream revitalised: preconditioning strategies to protect surgical flaps from critical ischaemia and ischaemia-reperfusion injury. Journal of plastic, reconstructive & aesthetic surgery. 2008;61(5):503-11.
3. Referans3 Bocci VA. Tropospheric ozone toxicity vs. usefulness of ozone therapy. Archives of medical research. 2007;38(2):265-7.
4. Referans4 Valacchi G, Bocci V. Studies on the biological effects of ozone: 11. Release of factors from human endothelial cells. Mediators of inflammation. 2000;9(6):271-6.
5. Referans5 Bocci VA. Scientific and medical aspects of ozone therapy. State of the art. Archives of medical research. 2006;37(4):425-35.
6. Referans6 Martínez-Sánchez G. Rectal Administration and its Application in Ozonetherapy. International Journal of ozone therapy. 2012;11(1).
7. Referans7 Bocci VA, Zanardi I, Travagli V. Ozone acting on human blood yields a hormetic dose-response relationship. Journal of Translational Medicine. 2011;9(1):1-11.
8. Referans8 Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJR, Alshahrour A, et al. Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound repair and regeneration. 2007;15(1):80-6.

9. Referans9 Görgülü T, Guler R, Olgun A, Torun M, Kargi E. Evaluation of the Effect of Bosentan-Mediated Endothelin Receptor Blockade on Flap Survival in Rats: An Experimental Study. Facial Plastic Surgery. 2016;32(04):431-7.
10. Referans10 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113-41.
11. Referans11 Stein HJ, Fayman MS, Oosthuizen MM, Hinder RA. Verapamil improves survival of rat hyperemic island skin flaps. Surgery. 1989;106(4):617-22; discussion 22-3.
12. Referans12 Aslan C, Melikoglu C, Ocal I, Saglam G, Sutcu R, Hosnuter M. Effect of epigallocatechin gallate on ischemia-reperfusion injury: an experimental study in a rat epigastric island flap. International journal of clinical and experimental medicine. 2014;7(1):57.
13. Referans13 Qi W, Tan D-X, Reiter RJ, Kim SJ, Manchester LC, Cabrera J, et al. Melatonin reduces lipid peroxidation and tissue edema in cerulein-induced acute pancreatitis in rats. Digestive diseases and sciences. 1999;44(11):2257-62.
14. Referans14 Kargi E, Deren O, Babuccu O, Hosnuter M, Erdogan B. Dual synergistic effect: the effect of dexamethasone plus carnitine on skin flap survival. Annals of plastic surgery. 2004;53(5):488-91.
15. Referans15 Gribbe O, Lundeberg T, Samuelson UE, Wiklund NP. Dexamethasone increases survival and attenuates induction of inducible nitric oxide synthase in experimental skin flaps. Annals of plastic surgery. 1999;42(2):180-4.
16. Referans16 Willemart G, Knight KR, Morrison WA. Dexamethasone treatment prior to reperfusion improves the survival of skin flaps subjected to secondary venous ischaemia. British journal of plastic surgery. 1998;51(8):624-8.
17. Referans17 Willemart G, Knight K, Ayad M, Wagh M, Morrison W. The beneficial antiinflammatory effect of dexamethasone administration prior to reperfusion on the viability of cold-stored skin flaps. International journal of tissue reactions. 1999;21(3):71-8.
18. Referans18 Zhang F, Fischer K, Komorowska-Timek E, Guo M, Cui D, Dorsett-Martin W, et al. Improvement of skin paddle survival by application of vascular endothelial growth factor in a rat TRAM flap model. Annals of plastic surgery. 2001;46(3):314-9.
19. Referans19 Kim HS, Noh SU, Han YW, Kim KM, Kang H, Kim HO, et al. Therapeutic effects of topical application of ozone on acute cutaneous wound healing. Journal of Korean medical science. 2009;24(3):368-74.
20. Referans20 Dianzani MU. 4-Hydroxynonenal and cell signalling. Free radical research. 1998;28(6):553-60.
21. Referans21 León O, Menéndez S, Merino N, Castillo R, Sam S, Pérez L, et al. Ozone oxidative preconditioning: a protection against cellular damage by free radicals. Mediators of inflammation. 1998;7(4):289-94.
22. Referans22 Peralta C, Xaus C, Bartrons R, Leon OS, Gelpí E, Roselló-Catafau J. Effect of ozone treatment on reactive oxygen species and adenosine production during hepatic ischemia-reperfusion. Free radical research. 2000;33(5):595-605.