Abstract
OBJECTIVE: Wound site skin necrosis is one of the main problems faced in surgical interventions. Surgical technique, infection, peripheric vascular diseases and radiation are the etiological factors. Various materials have been used for the purpose of avoiding the process which leads from inadequate wound healing to necrosis. Currently, most of these materials are inadequate in preventing necrosis. Amniomax is the enriched amniotic fluid containing various amniotic growth factors. In the rat dorsal skin necrosis model, our aim was to demonstrate the effectiveness of Amniomax when used intradermally.
MATERIAL AND METHODS: 3x10 cm-sized caudal-based dorsal skin flap drawings were made under anesthesia. 6 cm from the caudal was marked and 30-second blood flow measurement recordings were made from this level via doppler ultrasonography. By using McFarlane flap as a model, 3x10 cm-sized caudal-based dorsal skin flaps were removed. After the suturing, blood flow measurements from the 6 cm mark were repeated. Rats were randomly divided into 2 groups; namely as the control group (n=5) and the treatment group (amniomax group,n=5). Digital photography images were taken as a standard practice. Subcutaneous amniomax was applied to the treatment group. On the 10th day before the surgical operation, blood flow measurements from the caudal at 6 cm were repeated via doppler ultrasonography under sedation. Digital photography images were recorded again. Necrotic areas and blood flow rates of the flaps in both groups were calculated.RESULTS:The average surface area of the flaps removed from the rats in Group 1 was found to be 18.67 cm2 (±4.01) % whereas in Group 2 this value was found to be 47.94 cm2 ( ±5.03) %. Necrotic areas in Group 1 and Group 2 were found to be different at a statistically significant level in terms of necrotic areas (P < 0.05). In laser doppler measurements of blood flow performed after the surgical operation, an increase of 4.75 ( ±6.82)% and 59.84 (± 16.55) % were noted respectively in the control and treatment groups. The difference between these values was found to be statistically significant (P < 0.05).
CONCLUSIONS: In the future, the amniomax fluid containing growth factors can be used for therapeutic purposes in preventing skin necrosis.
Keywords
References
- Referans 1.Pedretti SLDC, Rena CL, Castãnon MCMN, Duque APDN, Pereira FH, Nunes TA : Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats. Rev Col Bras Cir 2017 : 44(5):457-464
- Referans 2.Şen H, Oruç M, Işik VM, Sadiç M, Sayar H, Çitil R, Korkmaz M, Koçer U : The Effect of Omeprazole Usage on the Viability of Random Pattern Skin Flaps in Rats Ann Plast Surg 2017 : 78(6):e5-e9
- Referans 3. Kaya B, Ergün H, Demirel M, Gültan MS, Emiroğlu M, Heper AO : Diyabetik ve Diyabetik Olmayan Sıçanlarda Flep Yașayabilirliğine “Rosiglitazon”un Etkisinin Araștırılması. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2012 : 65 (2) 119-124
- Referans 4. Aral M, Tuncer S, Şencan A : The effect of thrombolytic, anticoagulant, andvasodilator agents on the survival of random pattern skin flap. J Reconstr Microsurg 2015 : 31:487–492
- Referans 5. Livaoğlu M, Kerimoğlu S, Sönmez B : The effect of Hirudoid on random skin-flap survival in rats. J Plast Reconstr Aesthetic Surg 2010 , 63:1047–1051
- Referans 6. Rennie K, Gruslin A, Hengstschläger M, Pei D, Cai J, Nikaido T, Bani-Yaghoub M : Applications of amniotic membrane and fluid in stem cell biology and regenerative medicine Stem Cells Int 2012 : 1-13
- Referans 7. Klemmt PA, Vafaizadeh V, Groner B : “The potential of amniotic fluid stem cells for cellular therapy and tissue engineering,” Expert Opinion on Biological Therapy 2011: 1297–1314
- Referans 8. Kryger Z, Zhang F, Dogan T, Cheng C, Lineaweaver WC, Buncke HJ : The effects of VEGF on survival of a random flap in the rat: Examination of various routes of administration Br J Plast Surg 2000 : 53:234–239.
- Referans 9. Clauss M, Gerlach M, Gerlach H : Vascular permeability fac-23. tor: a tumor-derived polypeptide that induces endothelial cell and monocyte procoagulant activity, and promotes monocyte migration J Exp Med 1990 : 1;172(6):1535-1545
- Referans 10. Lin Y, Chang JC, Chin L, Xiaofang S, Jingwei Y, Yuet WK : Induced pluripotent stem cells offer new approach to therapy in thalassemia and sickle cell anemia and option in prenatal diagnosis in genetic diseases Proc Natl Acad Sci U S A 2009 :106(24): 9826–9830
- Referans 11. Geddes CR., Morris SF, Neligan PC : Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2013 ,:50(1):90-99
- Referans 12. Jokuszies A, Neubert N, Herold C , Vogt Early PM : Start of the Dangling Procedure in Lower Extremity Free Flap Reconstruction does not Affect the Clinical Outcome. J reconstr Microsurg 2013 : 29(01): 27-32
- Referans 13. Forrest CR, Pang CY, Zhong AG, Neligan PC : Role of noradrenaline in the pathogenesis of skin flap ischemic necrosis in the pig. J Surg Res 1990 :48(3):237-44
- Referans 14. Basu G, Downey H, Guo S : Prevention of distal flap necrosis in a rat random skin flap model by gene electro transfer delivering VEGF(165) plasmid. J Gene Med 2014 : 16:55–65
- Referans 15. Tang YH, Pennington LA, Scordino JW, Alexander JS, Lian T : Dynamics of early stem cell recruitment in skin flaps subjected to ischemia reperfusion injury. Pathophysiology 2016 , 23(3):221-228
- Referans 16. Fairbairn NG, Randolph MA, Redmond RW : The clinical applications of human amnion in plastic surgery . J Plast Reconstr Aesthet Surg 2014 : 662–675
- Referans 17. Streubel B, Martucci-Ivessa G, Fleck T, Bittner RE : In vitro transformation of amniotic cells to muscle cells—background and outlook. Wien Med Wochenschr 1996 : 216–217
- Referans 18. Atilla HA, Stubbs AJ : Amniyotik membran ve sıvı kaynaklı tedaviler – kök hücre tedavisi .TOTBİD Dergisi 2017 : 16:259–265
Abstract
AMAÇ: Yara yeri cilt nekrozu cerrahi girişimlerin ana problemlerinden biridir. Cerrahi teknik, enfeksiyon, periferik vasküler hastalıklar ve radyasyon etyolojik faktörlerdir. Yara iyileşmesindeki yetersizlikten nekroza giden süreci önlemek için çeşitli materyaller kullanılmıştır. Halen bunların çoğunluğu nekrozu önlemede yetersizdir. Amniomax, çeşitli amniyotik büyüme faktörleri içeren zenginleştirilmiş amniyon sıvısıdır. Rat dorsal cilt nekroz modelinde, Amniomax‘ı intradermal uygulayarak etkinliğini göstermeyi amaçladık.
GEREÇ VE YÖNTEM: Anestezi altında, kaudal bazlı 3x10 cm boyutlarında dorsal cilt flep çizimleri yapıldı. Kaudalden itibaren 6. cm işaretlendi ve bu düzeylerden dopler ultrason ile kan akımı ölçümleri 30 saniye kayıt edildi. McFarlane flep modeli kullanılarak kaudal bazlı 3x10 cm boyutlarında dorsal cilt flepleri kaldırıldı. Sütüre edildikten sonra 6.cm kan akım ölçümleri tekrarlandı. Ratlar rastlantısal olarak 2 gruba ayrıldı. Kontrol grubu (n=5) ve tedavi grubu (amniomax grubu, n=5). Dijital fotoğraf imajları standart olarak alındı. Tedavi gurubuna subkutan olarak amniomax uygulandı. Cerrahi işlem sonrası 10. günde sedasyon altında kaudalden 6.cm de dopler ultrason ile kan akım ölçümleri tekrarlandı. Dijital fotoğraf imajları tekrar kayıt edildi. Her iki gruptaki fleplerin nekroz alanları ve kan akım hızları hesaplandı.
BULGULAR: Grup I’deki ratlardan kaldırılan fleplerin yüzey alanının ortalama %18.67 cm2 (± 4.01) oranında nekroz olduğu, Grup II’de bu rakamın %47.94 cm2 (±5.03) olduğu bulundu. Nekroz alanları açısından Grup I ve Grup II’deki nekroz alanları istatistiksel olarak anlamlı düzeyde farklı bulundu (P < 0.05).İşlem sonrası yapılan lazer doppler ölçümlerinde, kontrol grubunda % 4.75 ( ±6.82), tedavi grubunda kan akım ölçümlerinde % 59.84 (± 16.55) oranında artış görüldü. Aralarındaki fark istatiksel olarak anlamlı bulundu (P < 0.05).
SONUÇ: İleriki dönemlerde amniyotik büyüme faktörleri içeren amniyomax sıvısı cilt nekrozu oluşmasını önlemede tedavi amaçlı kullanılabilir.
Keywords
References
- Referans 1.Pedretti SLDC, Rena CL, Castãnon MCMN, Duque APDN, Pereira FH, Nunes TA : Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats. Rev Col Bras Cir 2017 : 44(5):457-464
- Referans 2.Şen H, Oruç M, Işik VM, Sadiç M, Sayar H, Çitil R, Korkmaz M, Koçer U : The Effect of Omeprazole Usage on the Viability of Random Pattern Skin Flaps in Rats Ann Plast Surg 2017 : 78(6):e5-e9
- Referans 3. Kaya B, Ergün H, Demirel M, Gültan MS, Emiroğlu M, Heper AO : Diyabetik ve Diyabetik Olmayan Sıçanlarda Flep Yașayabilirliğine “Rosiglitazon”un Etkisinin Araștırılması. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2012 : 65 (2) 119-124
- Referans 4. Aral M, Tuncer S, Şencan A : The effect of thrombolytic, anticoagulant, andvasodilator agents on the survival of random pattern skin flap. J Reconstr Microsurg 2015 : 31:487–492
- Referans 5. Livaoğlu M, Kerimoğlu S, Sönmez B : The effect of Hirudoid on random skin-flap survival in rats. J Plast Reconstr Aesthetic Surg 2010 , 63:1047–1051
- Referans 6. Rennie K, Gruslin A, Hengstschläger M, Pei D, Cai J, Nikaido T, Bani-Yaghoub M : Applications of amniotic membrane and fluid in stem cell biology and regenerative medicine Stem Cells Int 2012 : 1-13
- Referans 7. Klemmt PA, Vafaizadeh V, Groner B : “The potential of amniotic fluid stem cells for cellular therapy and tissue engineering,” Expert Opinion on Biological Therapy 2011: 1297–1314
- Referans 8. Kryger Z, Zhang F, Dogan T, Cheng C, Lineaweaver WC, Buncke HJ : The effects of VEGF on survival of a random flap in the rat: Examination of various routes of administration Br J Plast Surg 2000 : 53:234–239.
- Referans 9. Clauss M, Gerlach M, Gerlach H : Vascular permeability fac-23. tor: a tumor-derived polypeptide that induces endothelial cell and monocyte procoagulant activity, and promotes monocyte migration J Exp Med 1990 : 1;172(6):1535-1545
- Referans 10. Lin Y, Chang JC, Chin L, Xiaofang S, Jingwei Y, Yuet WK : Induced pluripotent stem cells offer new approach to therapy in thalassemia and sickle cell anemia and option in prenatal diagnosis in genetic diseases Proc Natl Acad Sci U S A 2009 :106(24): 9826–9830
- Referans 11. Geddes CR., Morris SF, Neligan PC : Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2013 ,:50(1):90-99
- Referans 12. Jokuszies A, Neubert N, Herold C , Vogt Early PM : Start of the Dangling Procedure in Lower Extremity Free Flap Reconstruction does not Affect the Clinical Outcome. J reconstr Microsurg 2013 : 29(01): 27-32
- Referans 13. Forrest CR, Pang CY, Zhong AG, Neligan PC : Role of noradrenaline in the pathogenesis of skin flap ischemic necrosis in the pig. J Surg Res 1990 :48(3):237-44
- Referans 14. Basu G, Downey H, Guo S : Prevention of distal flap necrosis in a rat random skin flap model by gene electro transfer delivering VEGF(165) plasmid. J Gene Med 2014 : 16:55–65
- Referans 15. Tang YH, Pennington LA, Scordino JW, Alexander JS, Lian T : Dynamics of early stem cell recruitment in skin flaps subjected to ischemia reperfusion injury. Pathophysiology 2016 , 23(3):221-228
- Referans 16. Fairbairn NG, Randolph MA, Redmond RW : The clinical applications of human amnion in plastic surgery . J Plast Reconstr Aesthet Surg 2014 : 662–675
- Referans 17. Streubel B, Martucci-Ivessa G, Fleck T, Bittner RE : In vitro transformation of amniotic cells to muscle cells—background and outlook. Wien Med Wochenschr 1996 : 216–217
- Referans 18. Atilla HA, Stubbs AJ : Amniyotik membran ve sıvı kaynaklı tedaviler – kök hücre tedavisi .TOTBİD Dergisi 2017 : 16:259–265
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Publication Date | July 1, 2020 |
| Acceptance Date | January 16, 2020 |
| Published in Issue | Year 2020 Volume: 21 Issue: 3 |
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