TY - JOUR T1 - Results of a hemostatic agent to potentiate ischemia-induced skin flap necrosis in an experimental rat model TT - Deneysel sıçan modelinde iskemiye bağlı deri flep nekrozunda hemostatik ajan kullanım AU - Akbulut, Aylin AU - Gursoy, Koray AU - Yumusak, Nihat AU - Koca, Gokhan AU - Korkmaz, Meliha PY - 2019 DA - September DO - 10.18663/tjcl.589447 JF - Turkish Journal of Clinics and Laboratory JO - TJCL PB - DNT Ortadoğu Yayıncılık A.Ş. WT - DergiPark SN - 2149-8296 SP - 388 EP - 395 VL - 10 IS - 3 LA - en AB - Aim:Theuses of plant based hemostatic agents are increasingfor obtaining operative field hemostasis. However, their effects onvascularly challenged tissue is not known. The aim of this study wasto investigate the effect, if any, of plant-based hemostatic agent,Ankaferd (ABS) on flap viability in a rat model. Materialand Methods: Twentyrats underwent McFarlane flaps undergeneral anesthesia.Ten rats in Group I received no other treatment. Ten rats in Group IIreceived ABS to the underside of flaps. Viableflap area was determined in scintigraphic images and percentage ofviable flap area pixel size to the total flap area pixel size wascalculated.Additionally all flap areas were digitally photographed and underwenthistopathologic evaluation.Results:Scintigraphicanalysis has shown limited viability at proximal pedicle zone of flapin Group II compared to Group I. The mean area of flap survivalpercentage was calculated inGroup I and in Group II was asfollows respectively 56.33±9.94%,26.27±7.05%.Differences between groups were statistically significant (p<0.001).Similarly, Group II has shown significantlysmaller 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 weresignificantly high in Group II compared to Group I (p<0.001)whereas neovascularization was significantly low in Group IIcompared to Group I (p<0.001).Conclusion:Despiteits efficacy in surgical hemostasis,ABS use isassociated with an increased incidence of distal tip necrosis indorsal rat skin flaps. Therefore ABS use in marginally perfusedtissues particularly in random skin flaps should be cautious. KW - Flap Viability; Ankaferd; ABS (Ankaferd Blood Stopper); Hemostatic Agent N2 - Amaç:Operasyonalanlarında hemostazı elde etmek için bitki bazlı hemostatikajanların kullanımı artmaktadır. Ancak bu ajanların vaskülerkanlanmanın önemli olduğu durumlarda kullanımı ile ilgiliherhangi çalışma bulunmamaktadır.Kullanımıson yıllarda yaygınlaşan, bitki bazlı bir topikal hemostatik ajanolan Ankaferd’in (ABS) McFarlane flep viyabilitesiüzerindeki etkisini sıçanmodelindeinceledik.Gereçve Yöntemler:Yirmi sıçandaMcFarlanetarzı flepler genel anestezi altında eleve edildi. Sıçanların10’u Grup I olarak atandı ve başka ek tedavi uygulanmadı. GrupII'deki 10 sıçanın fleplerinin alt yüzlerine ABS uygulandı.Flepler orijinal yerlerine adapte edildikten sonraki 7. günde flapviabilitesi için sintigrafik çekim ve dijital olarak çekilenfotoğraflarla topografik analiz yapıldı. Canlı flep alanlarısintigrafik görüntülerde belirlendi ve bu alanların pikselleritotal flep alanına oranlandı. Sonrasında flep dokularıhistopatolojik olarak değerlendirildi.Bulgular:Sintigrafikanalizde, Grup I ile karşılaştırıldığında, Grup II’deflepin proksimal sap kesiminde sınırlı alanda viyabilite gözlendive 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 GrupI’e oranla anlamlı olarak yüksekti (p <0.001). Aynı şekildemakroskopik gözlemle uyumlu olarak ABS ile tedavi edilen sıçanlarkontrol grubu ile karşılaştırıldığında, topografik analizindebulunan canlıdoku alanı anlamlı olarak daha küçüktü(%26.81±5.55,karşın %59.66±12.04,p<0.001).Benzer şekilde histopatolojik sonuçlarda, ABS grubunda kontrolgrubuyla karşılaştırıldığında histopatolojik değişikliklerdeanlamlı artış (p <0.001), neovaskülarizasyonda anlamlı azalmasaptandı (p <0.001).Sonuç:Çalışmamızın sonucunda cerrahi hemostazdaki etkinliğine rağmen,ABS kullanımının özellikle cilt flepleri gibi marjinal olarakperfüze dokularda flep viyabilitesine olumsuz etkisi bulunmuştur.Dolayısıyla, vasküler damarlanmanın önemli olduğu dokularda ABSkullanımında dikkatli olunmalıdır CR - 1. Haznedaroglu BZ, Beyazit Y, Walker SL, Haznedaroglu IC. Pleiotropic cellular, hemostatic, and biological actions of Ankaferd hemostat. Crit Rev Oncol Hematol 2012; 83: 21–34. CR - 2. Ozel-Demiralp D, İğci N, Ayhan B, Eğin Y, Haznedaroglu IC, Akar N. 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