Rinoplasti için iki yeni greft tekniği: Tavşan modelinde deneysel çalışma
Yükleniyor...
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Dorsum augmentasyonu rinoplastinin zor aşamalarından biridir. Günümüzde burundaki düzensizlikleri gidermek ve dorsumu augmente etmek amacıyla kullanılan kıyılmış kıkırdak greftleri oldukça popüler hale gelmiştir. Kıyılmış kıkırdakları bir arada tutmak, burna istenilen şekli vermek, görünürlüğü azaltmak ve kıkırdak kalitesini arttırmak amacıyla pek çok sarma materyali tarif edilmiştir. Son çalışmalar kıyılmış kıkırdakların fasya ile sarılması durumunda oldukça başarılı sonuçlar elde edilebileceğini göstermiştir. Dermis greftleri hem daha kısa zamanda alınabilmesi hem de çok daha az donör alan morbiditesine yol açması sebebiyle fasyaya alternatif olabilecek niteliktedir. Detaylı literatür taramasına rağmen kıyılmış kıkırdağı sarma amacıyla kullanılan dermis greftine dair veri bulamadık. Yine rinoplastide pek çok otojenik doku, greft amacıyla kullanılmasına rağmen tendon kullanımına dair bir çalışma yoktur. Bu çalışmada, rinoplastide kullanılabilmesi için kıkırdak greftine alternatif olarak tendon grefti ve kıkırdağı sarmak amacıyla dermis grefti olmak üzere tanımladığımız iki yeni greft tekniğinin yaşayabilirliğinin ve kalıcılığının değerlendirilmesi amaçlandı. Gereç ve Yöntem: On altı adet Yeni Zelanda türü beyaz tavşandan iki adet lumbosakral fasya, bir adet dermis grefti, bir adet aşil tendonu alındı. Tavşanların sağ kulağı ampute edildikten sonra, cilt ve perikondriyum uzaklaştırıldı. Kulak kıkırdağı ve aşil tendonu 1 mm küplük parçalar halinde dilimlendi. Dört deney grubu oluşturuldu. Birinci grupta kıyılmış kıkırdak greftleri herhangi bir materyale sarılmadı (A grubu); ikinci grupta kıyılmış kıkırdak greftleri fasya ile sarıldı (B grubu); üçüncü grupta kıyılmış kıkırdak greftleri dermis ile sarıldı (C grubu); dördüncü grupta ise kıyılmış tendon greftleri fasya ile sarıldı. Her tavşanın sırtına dörder adet cilt altı cep oluşturuldu ve greftler ceplere yerleştirildi. On altı haftalık gözlem sonrasında tavşanlar sakrifiye edilip, greftler çıkarıldı. Deney süresince üç tavşan öldüğü için çalışmaya dahil edilmedi (n=13). Makroskobik olarak greftlerin düzenli olup olmadıklarına bakıldı ve hacim değişiklikleri ölçüldü. Histolojik inceleme için preparatlar Hematoksilen-Eozin, Masson trikrom ve Van Gieson ile boyandı. İstatistiksel anlamlılık sınırı olarak p<0.05 kabul edildi. Bulgular: Canlı kalan on üç tavşanda greftlerin yerinde olduğu ve hiçbir greftte total rezorpsiyon olmadığı izlendi. Kıyılmış kıkırdak, fasya ile sarılmış kıyılmış kıkırdak ve dermis ile sarılmış kıyılmış kıkırdak gruplarında hacim artışı olduğu ve bu üç gruptaki hacim değişimi kıyaslandığında aralarında anlamlı bir fark olmadığı izlendi. Fasya ile sarılmış kıyılmış tendon grubunda ise bir miktar hacim azalması tespit edildi, ancak bu değişim istatistiksel olarak anlamlı bulunmadı. Fasya ve dermis ile sarılmış kıyılmış kıkırdak gruplarında periferal proliferasyon daha yüksek izlendi. Fasya ile sarılmış kıyılmış tendon grubunda fibrozis, fragmentasyon ve kollajen lif miktarının daha fazla olduğu, elastik lif miktarının ise daha düşük olduğu tespit edildi. Diğer histolojik parametreler açısından gruplar arasında anlamlı fark görülmedi. Sonuç: Çalışmadan elde edilen bulgular sonucunda dermis ile sarılmış kıyılmış kıkırdak greftleri ile kıyılmış tendon greftleri başta dorsum augmentasyonu olmak üzere, rinoplasti operasyonları için iyi birer alternatif olabilir. Bu tekniklerin insanda klinik kullanımı için daha fazla çalışma yapılması gerekmektedir.
Introduction: Dorsum augmentation is one of the most challenging stages of rhinoplasty. Diced cartilage grafts used to correct nasal irregularities and augment the dorsum, have become quite popular recently. Many wrapping materials have been described in order to hold the diced cartilages together, to give the desired shape to the nose, to reduce the visibility and to increase the cartilage quality. Recent studies have shown that highly successful results can be achieved if the diced cartilages are wrapped in fascia. Dermis grafts can be an alternative to fascia because they can be taken in a shorter time and cause much less morbidity in the donor area. Despite a detailed literature review, we could not find any data on the diced cartilage wrapped in dermis. On the other hand although many autogenic tissues have been used as graft material in rhinoplasty, there is no study on the use of tendons. In this study, it was aimed to evaluate the viability and longevity of two new graft techniques defined by us for rhinoplasty; tendon graft as an alternative to cartilage graft and dermis graft to wrap the diced cartilages. Material and Method: Two lumbosacral fascias, a dermis graft, and a Achilles tendon were obtained from sixteen New Zealand white rabbits. After the right ear of the rabbits was amputated, the skin and perichondrium were removed. Ear cartilage and Achilles tendon were diced into 1 mm pieces. Four experimental groups were formed. In the first group, the diced cartilage grafts were not wrapped in any material (group A); in the second group, the diced cartilage grafts were wrapped in fascia (group B); in the third group, the diced cartilage grafts were wrapped in dermis (group C); in the fourth group, the diced tendon grafts were wrapped in fascia. Four subcutaneous pockets were created on the back of each rabbit and the grafts were placed in the pockets. After 16 weeks of observation, the rabbits were sacrificed and the grafts were removed. Since three rabbits died during the experiment, they were not included in the study (n=13). Macroscopically volume changes were measured and grafts' regularity were inspected. Then grafts were stained with Hematoxylin-Eosin, Masson trichrome and Van Gieson for histological examination. Results were evaluated at a P<0.05 significance level. Results: It was observed that all the grafts remained in the pockets where they were placed in 13 surviving rabbits and there was no total resorption in any of the grafts. A volume increase was detected in the groups of diced cartilage, diced cartilage wrapped in fascia, and diced cartilage wrapped in dermis, and there was no statistically significant difference when the volume changes of these three groups were compared. There was a little volume reduction in the diced tendon grafts wrapped in fascia, but this change was not statistically significant. Peripheral proliferation was higher in diced cartilage groups wrapped in fascia and dermis. Our histological analysis demonstrated that the amount of fibrosis, fragmentation and collagen fiber was higher, however the amount of elastic fiber content was less in the diced tendon grafts wrapped in fascia. There was no statistically significant difference between the groups in terms of other histological parameters. Conclusion: The result of our experimental study suggest that diced cartilage grafts wrapped in dermis and diced tendon grafts may be good alternatives for rhinoplasty operations particularly in the respect of dorsum augmentation. Further studies are required for clinical use of these techniques in human beings.
Introduction: Dorsum augmentation is one of the most challenging stages of rhinoplasty. Diced cartilage grafts used to correct nasal irregularities and augment the dorsum, have become quite popular recently. Many wrapping materials have been described in order to hold the diced cartilages together, to give the desired shape to the nose, to reduce the visibility and to increase the cartilage quality. Recent studies have shown that highly successful results can be achieved if the diced cartilages are wrapped in fascia. Dermis grafts can be an alternative to fascia because they can be taken in a shorter time and cause much less morbidity in the donor area. Despite a detailed literature review, we could not find any data on the diced cartilage wrapped in dermis. On the other hand although many autogenic tissues have been used as graft material in rhinoplasty, there is no study on the use of tendons. In this study, it was aimed to evaluate the viability and longevity of two new graft techniques defined by us for rhinoplasty; tendon graft as an alternative to cartilage graft and dermis graft to wrap the diced cartilages. Material and Method: Two lumbosacral fascias, a dermis graft, and a Achilles tendon were obtained from sixteen New Zealand white rabbits. After the right ear of the rabbits was amputated, the skin and perichondrium were removed. Ear cartilage and Achilles tendon were diced into 1 mm pieces. Four experimental groups were formed. In the first group, the diced cartilage grafts were not wrapped in any material (group A); in the second group, the diced cartilage grafts were wrapped in fascia (group B); in the third group, the diced cartilage grafts were wrapped in dermis (group C); in the fourth group, the diced tendon grafts were wrapped in fascia. Four subcutaneous pockets were created on the back of each rabbit and the grafts were placed in the pockets. After 16 weeks of observation, the rabbits were sacrificed and the grafts were removed. Since three rabbits died during the experiment, they were not included in the study (n=13). Macroscopically volume changes were measured and grafts' regularity were inspected. Then grafts were stained with Hematoxylin-Eosin, Masson trichrome and Van Gieson for histological examination. Results were evaluated at a P<0.05 significance level. Results: It was observed that all the grafts remained in the pockets where they were placed in 13 surviving rabbits and there was no total resorption in any of the grafts. A volume increase was detected in the groups of diced cartilage, diced cartilage wrapped in fascia, and diced cartilage wrapped in dermis, and there was no statistically significant difference when the volume changes of these three groups were compared. There was a little volume reduction in the diced tendon grafts wrapped in fascia, but this change was not statistically significant. Peripheral proliferation was higher in diced cartilage groups wrapped in fascia and dermis. Our histological analysis demonstrated that the amount of fibrosis, fragmentation and collagen fiber was higher, however the amount of elastic fiber content was less in the diced tendon grafts wrapped in fascia. There was no statistically significant difference between the groups in terms of other histological parameters. Conclusion: The result of our experimental study suggest that diced cartilage grafts wrapped in dermis and diced tendon grafts may be good alternatives for rhinoplasty operations particularly in the respect of dorsum augmentation. Further studies are required for clinical use of these techniques in human beings.
Açıklama
Anahtar Kelimeler
Dermis grefti, Kıyılmış tendon grefti, Kıyılmış kıkırdak grefti, Rinoplasti, Tendon grefti, Dorsum augmentasyonu, Dermis graft, Diced tendon graft, Diced cartilage graft, Rhinoplasty, Tendon graft, Dorsum augmentation
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özdemir, M. (2022). Rinoplasti için iki yeni greft tekniği: Tavşan modelinde deneysel çalışma. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
