Enoksaparin ve rivaroksabanın cilt degloving yaralanmalarında doku sağkalımı üzerindeki etkisi: Deneysel çalışma

Öz

Amaç: Çalışmamızda degloving yaralanması sonrası antitrombotik ajanlar enoksaparin ve rivaroksabanın doku sağkalımı üzerindeki etkilerini deneysel sıçan kuyruk modelinde incelemeyi amaçladık.

Çalışma planı: Yirmi dört sıçan üç eşit gruba ayrıldı (n=8): Enoksaparin verilen grup (Grup 1), rivaroksaban verilen grup (Grup 2) ve serum fizyolojik verilen kontrol grubu (Grup 3). Tüm sıçanların kuyruklarının başlangıcının yaklaşık 5 cm distalinden dairesel kesi yapıldıktan sonra kesinin distalindeki kuyruk derisine elle traksiyon uygulanarak degloving yaralanma sahası oluşturuldu. On beş dakika beklendikten sonra kesi uçları yerlerine dikildi. Dikişten hemen sonra antitrombotik ajanlar sıçanlara verildi ve işlem 15 gün boyunca günde bir kez tekrarlandı. On beşinci gün sonunda deney sonlandırıldı. Doku sağkalımı morfolojik ve histopatolojik olarak değerlendirildi.

Bulgular: Histopatolojik incelemede enoksaparin ve rivaroksaban gruplarında çoğunlukla normal cilt veya minimal enflamasyonun eşlik ettiği sağlam cilt görüldü. Nekrotik alanın kontrol grubundaki uzunluğu enoksaparin ve rivaroksaban gruplarına göre anlamlı derecede daha fazlaydı (p<0.05). Enoksaparin rivaroksaban grupları arasında istatistiksel olarak anlamlı fark saptanmadı (p=0.451). Ortalama nekrotik cilt uzunluğu kontrol grubunda çalışma gruplarına göre anlamlı düzeyde daha büyük iken (p<0.05), enoksaparin ve rivaroksaban grupları arasında nekrotik cilt uzunluğu açısından istatistiksel olarak anlamlı fark saptanmadı (p=0.722).

Çıkarımlar: Sıçan kuyruklarında degloving yaralanma modelinde, enoksaparin ve rivaroksaban kullanımının histopatolojik ve morfolojik bulgular bakımından doku sağkalımını arttırmaktadır.

Anahtar Kelimeler

• Degloving yaralanma; doku sağkalımı; enoksaparin; rat; rivaroksaban.

Effects of enoxaparin and rivaroxaban on tissue survival in skin degloving injury: an experimental study

Abstract

Objective: The aim of this study was to evaluate the effects of the antithrombotic agents enoxaparin and rivaroxaban on tissue survival following skin degloving injury in an experimental rat tail model.

Methods: The study included 24 rats divided into three equal groups of 8; the enoxaparin group (Group 1), the rivaroxaban group (Group 2) and the saline control group (Group 3). A degloving injury was created by making a circular incision 5 cm distal to the base of the tail; manual traction was applied to the tail skin distal to the incision. After 15 minutes, the ends of the incision were sutured back in place. Antithrombotic agents were administered immediately after suturing and repeated once a day for 15 days. At the end of Day 15, the experiment was terminated. Gross morphological tissue survival and histopathology were evaluated.

Results: Histopathological examination of the enoxaparin and rivaroxaban groups revealed that the skin was mostly normal or intact with minimal inflammation. The mean length of necrotic area was significantly higher in the saline group compared to the enoxaparin and rivaroxaban groups (p<0.05). No statistically significant differences were noted between the rivaroxaban and enoxaparin groups (p=0.451). The mean extent of skin necrosis was significantly higher in the control group than the study groups (p<0.05), while there was no significant difference in the length of necrotic area between Group 1 and 2 (p=0.722).

Conclusion: Rivaroxaban and enoxaparin improved tissue survival in skin degloving injuries in terms of gross morphological and histopathological findings in a rat tail model.

Keywords

• Degloving injury
• enoxaparin
• rat
• rivaroxaban
• tissue survival

Kaynakça

1. Adani R, Pataia E, Tarallo L, Mugnai R. Results of replan- tation of 33 ring avulsion amputations. J Hand Surg Am 2013;38:947-56. CrossRef
2. Chi Z, Gao W, Yan H, Li Z, Chen X, Zhang F. Re- construction of totally degloved fingers with a spiraled parallelogram medial arm free flap. J Hand Surg Am 2012;37:1042-50. CrossRef
3. Urbaniak JR, Evans JP, Bright DS. Microvascular man- agement of ring avulsion injuries. J Hand Surg Am 1981;6:25-30. CrossRef
4. Qi W, Chen KJ. Use of twin dorsal middle phalangeal fin- ger flaps for thumb or index finger reconstruction. J Hand Surg Eur Vol 2013;38:387-93. CrossRef
5. Musgrave RH, Lehman JA. Composite grafts. In: Geor- giade G, Georgiade NG, Riefkohl R, Barwick WJ, editors. Textbook of plastic, maxillofacial and reconstructive sur- gery. 2nd ed. Baltimore, MD: Williams & Wilkins; 1992. p. 47.
6. Cram AE, Chang P. Clinical applications of free skin grafts. In: Janusz Bardach, editor. Local flaps and free skin grafts. St. Louis, MO: Mosby; 1992. p. 157.
7. Ibbotson T, Goa KL. Enoxaparin: an update of its clini- cal use in the management of acute coronary syndromes. Drugs 2002;62:1407-30. CrossRef
8. Ertaş NM, Goldman C, Deitcher S, Siemionow M. Dose response of enoxaparin at the cremaster muscle flap mi- crocirculation. Microsurgery 2005;25:147-51. CrossRef

9. Miyawaki T, Jackson IT, Elmazar H, Bier UC, Barakat K, Andrus L, et al. The effect of low-molecular-weight hepa- rin in the survival of a rabbit congested skin flap. Plast Re- constr Surg 2002;109:1994-9. CrossRef
10. Perzborn E, Strassburger J, Wilmen A, Pohlmann J, Roeh- rig S, Schlemmer KH, et al. In vitro and in vivo studies of the novel antithrombotic agent BAY 59-7939--an oral, di- rect Factor Xa inhibitor. J Thromb Haemost 2005;3:514- 21. CrossRef
11. Biemond BJ, Perzborn E, Friederich PW, Levi M, Buete- horn U, Büller HR. Prevention and treatment of experi- mental thrombosis in rabbits with rivaroxaban (BAY 597939)-an oral, direct factor Xa inhibitor. Thromb Hae- most 2007;97:471-7.
12. Oztuna V, Eskandari MM, Unal S, Colak M, Karabacak T. The effect of pentoxifylline in treatment of skin deglov- ing injuries: an experimental study. Injury 2006;37:638- 41. CrossRef
13. Weinz C, Schwarz T, Kubitza D, Mueck W, Lang D. Me- tabolism and excretion of rivaroxaban, an oral, direct fac- tor Xa inhibitor, in rats, dogs, and humans. Drug Metab Dispos 2009;37:1056-64. CrossRef
14. Pressure ulcers prevalence, cost and risk assessment: con- sensus development conference statement--The National Pressure Ulcer Advisory Panel. Decubitus 1989;2:24-8.
15. Demirtas A, Azboy I, Bulut M, Ucar BY, Alabalik U, Il- gezdi S. Effect of hyperbaric oxygen therapy on healing in an experimental model of degloving injury in tails of nicotine-treated rats. J Hand Surg Eur Vol 2013;38:405- 11. CrossRef
16. Milcheski DA, Nakamoto HA, Tuma P Jr, Nóbrega L, Ferreira MC. Experimental model of degloving injury in rats: effect of allopurinol and pentoxifylline in improving viability of avulsed flaps. Ann Plast Surg 2013;70:366-9.
17. Nelson RM, Cecconi O, Roberts WG, Aruffo A, Lin- hardt RJ, Bevilacqua MP. Heparin oligosaccharides bind L- and P-selectin and inhibit acute inflammation. Blood 1993;82:3253-8.
18. Mazzoni MC, Schmid-Schönbein GW. Mechanisms and consequences of cell activation in the microcirculation. Cardiovasc Res 1996;32:709-19. CrossRef
19. Borris LC. Rivaroxaban and dabigatran etexilate: two new oral anticoagulants for extended postoperative prevention of venous thromboembolism after elective total hip ar- throplasty. Arch Orthop Trauma Surg 2010;130:583-9.