Sefalik pediküllü, random paternli dorsal rat deri flebinde danazol kullanımının flep yaşamı üzerine etkisi
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Tarih
2017
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info:eu-repo/semantics/openAccess
Özet
Vücudun d örtü tabakas olan cildin büyük defektlerinin kapat lmas , rekonstrüktif cerrahinin önemli sorunlar ndan biridir. Bilindi i gibi cilt defektlerinin kapat lmas nda en uygun fonksiyonel ve estetik yakla m fleplerin kullan lmas d r. Büyük defektlerin kapat lmas nda kullan lan fleplerin boyutlar da s n rl d r. Planlanan flebin boyu uzad kça flep ya ayabilirli inde azalma olmakta bu durum kendisini özellikle distalde nekroz ve doku kayb olarak göstermektedir. Deri flep kayb n aç klamak için iskemi, inflamasyon ve sempatektomi kombinasyonlar ileri sürülmü tür. Ayr ca yeterli besin sirkülasyonu sa lanamazsa flep hasar n n geri dönü ümsüz hale geldi i ifade edilmi tir.. Flep nekrozu olu tu u zaman sekonder iyile meye yard mc olmak amac yla zaman alan ve tekrarlayan pansumanlar ve hatta ikinci bir operasyon gerekebilmektedir. Bu durum hastanede yat süresini, morbiditeyi ve maliyeti art rmaktad r. Bu sorunlar giderebilmek için kan ak m n art ran sempatolitik ajanlar ve antikoagülanlar, kan n reolitik özelli ini de i tiren ajanlar kullan lm ayr ca iskemik hücrelerde hücre zar stabilizasyonu sa lanmaya çal lm t r Bu çal mada random paternli deri flebinin distal k sm nda nekroz geli imini azaltmak suretiyle ya ayabilirli ini art rmak için danazol kullan lm t r. Çal mada deney hayvan olarak di i, eri kin, 250-300gr a rl nda Sprague-Dawley s çan kullan ld . Denekler her biri 10 ar adetten olu an grup 1 (kontrol grubu) ve grup 2 (danazol grubu) olmak üzere iki gruba ayr ld . Deney hayvanlar na IM 90mg/kg a Ketamine-HCL (ketalar 50mg/mlt 10ml flk Phizer Warner Lambert) ve 10mg/kg Xylasine-HCL (Rompun 50ml Bayer) uygulamas yla anestezi sa land . S çanlar n s rt bölgesinde pedikülü sefalik tarafta ve pannikulus karnosus u içerecek ekilde olan 2.5*8cm ebad nda random paternli deri flebi kald r ld . Flep 4/0 atravmatik ipek ile kontinü olarak yata na sütüre edildi. Buraya kadar yap lan i lemler iki gruba da uyguland . Kontrol grubundaki s çanlara plasebo amac yla preoperatif 1. saatte ve postoperatif 1. günden itibaren izotonik NaCl (izotonik sodyum klorür %0.9 1000mlt Eczac ba /Baxter) 1cc olarak gavaj yoluyla 7 gün verildi. Danazol grubundaki s çanlara 3.6mg/100gr danazol (danasin tab. 50mg, Koçak) 100cc lik su içinde 1000mg olacak ekilde süspansiyon haline getirilerek toplam 1cc gavaj yoluyla preoperatif 1. saatte xi verildi. Postoperatif 1. günden itibaren total doz bir defada ve 24 saatte bir olacak ekilde 7 gün verildi. Postoperatif yedinci günde, bütün fleplerde nekroz alanlar milimetrik ka tlarla ölçülüp kaydedildi. Kaydedilen canl flep alanlar tüm flep alan na bölünüp, canl flep alan yüzdeleri bulundu. Elde edilen de erler Student s t-test ile de erlendirildi. p < 0.05 de eri istatistiksel anlaml l k s n r olarak kabul edildi. Danazol ün etkisini daha iyi gösterebilmek için, postoperatif yedinci günde, nekroz ve canl doku hatt ndan biyopsi al narak histopatolojik de erlendirme yap ld . Postoperatif 7. günde kontrol grubu ile danazol grubu makroskopik olarak kar la t r ld . Danazol grubundaki s çanlarda distal flep nekrozunun daha az ve ya ayabilen flep alan n n daha fazla oldu u görüldü. Student s t testi ile de erlendirilen iki gruptaki fleplerin canl alan yüzdeleri istatistiksel olarak danazol grubunda yüksek olarak bulundu. Sonuç olarak danazolün random paternli deri flebi ya ayabilirli ini art rd görüldü. Danazolün random deri flebinin distalinde nekrozu azaltmas , antiinflamatuar ve antikoagülan etkileriyle olu mu olabilir. Ancak bir çok organda farkl fizyolojik mekanizmalarla de i ik etkilere yol açmas yan etkilerini art rmaktad r. Bu durum dezavantaj d r. Antiinflamatuar etkinli i ile antikoagülan etkinli inin doza ba ml olarak de i mesi ise ilac n avantaj olabilir. Dolay s yla flep ya ayabilirli ine katk sa lad ve olumsuz etkilerinin daha az görüldü ü doz aral n n bulunmas için çal malar n sürmesi gerekmektedir. Anahtar Kelimeler: Danazol, deri flebi, yaşayabilirlik
Closure of large defects on skin that is outer layer of skin is one of the most challenging problem on reconstructive surgery. As known that, the most suitable functional and aesthetic way for closure of skin defects are to use flaps. But flaps which used for large skin defects lenght are limited. As planned flap s height lenghtens, flap surviving decreases. In this situation, necrosis and tissue lost is encorded. Combination of ischemia, inflammation, and symphatectomy as adeuquate nutritional circulation is not provided, it is proposed that injury of flap becomes irreversible. When flap necrosis occurs, repetitive dressing changes that take for a long time and also maintaining secondary operation are necessary. This condition increases overnight stay in hospital, morbidity and cost. To prevent this problems, symphatolytic agents and anticoagulans which increases blood flow and also agents that changes reolytic property of blood are used. Moreover, cell membrane stabilization is tried to be maintained. In this study, danazol is used for increasing survival of flap by decresing development of necrosis on distal part of random pattern skin flap. In this study, 250- 300 gr in weight female Spraque Dawley rats were used. Rats were divided into two groups as group one and two that each group composed of ten rats. Anesthesia was provided by applying IM 90 mg/kg Ketamine HCL (ketelar 50 mg/mlt 10 ml flk Phizer Warner Lambert) and 10 mg/kg Xylasine HCL (Rompun 50 ml Bayer) intramuscular. Random pattern skin flap 2.5x8 cm in height which includes panniculosis carnosus and their pedicles on side of cephalic part were elevated on the dorsum of the rats. Skin flap was sutured with continue with 4/0 atravmatik silk suture. This procedure were applied to each groups. Isotonic NaCI (izotonik sodyum klorür %0.9 1000 mlt Eczac ba ,Batter) for placebo was given to rats by the way of gavaj preoperative and postoperative first hour dating from first day along seven days. At postoperative seventh day, all of the flaps necrosis areas were measured by milimetric paper and were recorded. Surviving flap areas were divided into total flap area and found out their percentage. Student s t test was used to evaluate and p<0.05 value was accepted as statistical meaningfulness border. To point out danazol s effect; at postoperative xiii seventh day, biopsi taken from necrosis and living tissue border and histopatologic evaluation were made. At postoperative seventh day, danazol group was compared with control group macroscopically. In danazol group, flap necrosis was less and surviving flap area was more. Flaps surviving areas percentages in two groups which were evaluated by Student s t test were higher in danazol group statistically. As a result, danazol increases random pattern skin flap survival slightly. Danazol can decrease random pattern skin flap necrosis due to the fact that danazol has anticoagulant and anti-inflammation property. However, it increases its side effects due to the fact that it causes different effects in most of organs by various physiological mechanisms. This condition is its disadvantage. It might be the advantage of the drug that anticoagulant and anti-inflammation effect change depending upon its dose. For this reason, the studies should continue to find out dose interval that seen less side effect and also to provide flap survival. Key words: Danazol, skin flap, survival
Closure of large defects on skin that is outer layer of skin is one of the most challenging problem on reconstructive surgery. As known that, the most suitable functional and aesthetic way for closure of skin defects are to use flaps. But flaps which used for large skin defects lenght are limited. As planned flap s height lenghtens, flap surviving decreases. In this situation, necrosis and tissue lost is encorded. Combination of ischemia, inflammation, and symphatectomy as adeuquate nutritional circulation is not provided, it is proposed that injury of flap becomes irreversible. When flap necrosis occurs, repetitive dressing changes that take for a long time and also maintaining secondary operation are necessary. This condition increases overnight stay in hospital, morbidity and cost. To prevent this problems, symphatolytic agents and anticoagulans which increases blood flow and also agents that changes reolytic property of blood are used. Moreover, cell membrane stabilization is tried to be maintained. In this study, danazol is used for increasing survival of flap by decresing development of necrosis on distal part of random pattern skin flap. In this study, 250- 300 gr in weight female Spraque Dawley rats were used. Rats were divided into two groups as group one and two that each group composed of ten rats. Anesthesia was provided by applying IM 90 mg/kg Ketamine HCL (ketelar 50 mg/mlt 10 ml flk Phizer Warner Lambert) and 10 mg/kg Xylasine HCL (Rompun 50 ml Bayer) intramuscular. Random pattern skin flap 2.5x8 cm in height which includes panniculosis carnosus and their pedicles on side of cephalic part were elevated on the dorsum of the rats. Skin flap was sutured with continue with 4/0 atravmatik silk suture. This procedure were applied to each groups. Isotonic NaCI (izotonik sodyum klorür %0.9 1000 mlt Eczac ba ,Batter) for placebo was given to rats by the way of gavaj preoperative and postoperative first hour dating from first day along seven days. At postoperative seventh day, all of the flaps necrosis areas were measured by milimetric paper and were recorded. Surviving flap areas were divided into total flap area and found out their percentage. Student s t test was used to evaluate and p<0.05 value was accepted as statistical meaningfulness border. To point out danazol s effect; at postoperative xiii seventh day, biopsi taken from necrosis and living tissue border and histopatologic evaluation were made. At postoperative seventh day, danazol group was compared with control group macroscopically. In danazol group, flap necrosis was less and surviving flap area was more. Flaps surviving areas percentages in two groups which were evaluated by Student s t test were higher in danazol group statistically. As a result, danazol increases random pattern skin flap survival slightly. Danazol can decrease random pattern skin flap necrosis due to the fact that danazol has anticoagulant and anti-inflammation property. However, it increases its side effects due to the fact that it causes different effects in most of organs by various physiological mechanisms. This condition is its disadvantage. It might be the advantage of the drug that anticoagulant and anti-inflammation effect change depending upon its dose. For this reason, the studies should continue to find out dose interval that seen less side effect and also to provide flap survival. Key words: Danazol, skin flap, survival
Açıklama
Anahtar Kelimeler
Danazol, Deri flebi, Yaşayabilirlik, Skin flap, Survival
