Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Deneysel Epigastrik Ada Flep Modeli Yaşayabilirliğinde Hiperbarik Oksijen Ve/veya Antioksidan Vitamin Kombinasyonunun Etkinliği
EFFECTS OF HYPERBARIC OXYGEN AND/OR ANTIOXIDANT VITAMINCOMBINATION ON VIABILITY OF EXPERIMENTAL EPIGASTRIC ISLAND SKIN FLAPS
Şükrü ÖTER*, Ahmet KORKMAZ*
*, GATA Fizyoloji AD, ANKARA
Turkiye Klinikleri J Med Sci. 1999;19(2):73-7
Article Language: TR
ÖZET
İskemiye maruz kalmış bir flepte perfüzyonun yeniden sağlanması flep surveyini garanti etmeye yeterli değildir. Aksine reperfüzyon ile beraber oluşan serbest oksijen radikallerinin neden olacağı daha ileri hasarlar meydana gelebilmektedir. Özellikle E ve C vitaminleri olmak üzere, çeşitli antioksidan vitaminleri kullanarak, deri fleplerindeki reaktif oksijen türevi (ROT) kaynaklı zararlı etkilerin azaltılabildiği gösterilmiştir. Flep yaşayabilirliğinin hiperbarik oksijen (HBO) uygulamaları ile de arttırılabildiği yönünde bulgular vardır. Bu bilgiler ışığında gerçekleştirilen bu araştırmada, E ve C vitaminleri ile HBO uygulamalarının sıçan epigastrik ada flep modelinin yaşabilirliği üzerine olan etkisi incelenmiştir. Deney için, Sprague-Dawley türü dişi sıçanlar 10'ar hayvanlık 4 eşit gruba ayrılmıştır: Kontrol, HBO, Vitamin (E+C), HBO + Vitamin (E+C). Anestezi sonrasında hayvanların karın bölgesi traşlanarak 6x3.5 cm boyutlarında epigastrik ada deri flebi kaldırıldı. Sonra, epigastrik arter ve veni içeren, inferior epigastrik pedikül klampe edilerek flep tekrar yerine dikildi. 8 saatlik iskemik süresinden sonra klempler açılarak dokunun reperfüzyonu sağlandı. HBO, 7 gün boyunca, 2.5 ATA basınç altında, günde 1 kez ve 1 saat süreyle uygulanırken, vitamin (E+C) kombinasyonuna (40+200 mg/kg), ilk dozu operasyondan 3 gün önce olmak üzere 3 günde bir devam edilerek toplam 4 doza tamamlandı. Postoperatif 7. günde flep yaşayabilirlik oranları değerlendirildi; buna göre canlı flep alanı kontrol grubunda %28.6±6.9, HBO grubunda %59.2±3.8, HBO + vitamin grubunda %66.3±5.9, vitamin (E+C) grubunda ise 82.0±3.9 olarak bulundu. Her üç deney grubunda da flep yaşayabilirliği kontrol grubuna göre anlamlı düzeyde artmış bulundu (p<0.01). Denebilir ki, antioksidan vitamin E ve C flep yaşayabilirliğini son derece olumlu yönde etkilemiş, bunun yanında HBO'nun etkinliği ise relatif olarak zayıf kalmış ve ilave araştırmalara gereksinim bırakmıştır.

Anahtar Kelimeler: Hiperbarik oksijen, Antioksidan vitamin, Deri flebi
ABSTRACT
Reperfusion is not enough to guarantee the survey in a flap subjected to ischaemia. Conversely, further damage caused by reactive oxygen species (ROS) produced together with reperfusion may occur. It was shown that harmful effects of ROS in skin flaps can be reduced by using different antioxidant vitamins such as vitamins E and C. There are also reports that flap survey may increase with hyperbaric oxygen (HBO) treatment. In this study, performed in the light of these data, effects of vitamins E and C and HBO exposure on rat epigastric skin flap survival were investigated. 40 Sprague-Dawley rats were divided into four equal group as control, HBO, vitamin (E+C), HBO + vitamin (E+C). Abdominal area of animals were shaved after anesthesia and epigastric skin flaps, in the dimensions of 6x3.5 cm, were raised. After clamping inferior epigastric pedicle, including epigastric artery and vein, flaps were resutured into its bed. Reperfusion was obtained by removing the clamps after 8 hours of ischaemia. HBO exposure was performed at 2.5 ATA for one hour duration once a day and was continued seven days. Combination of vitamin E and C (40+200 mg/kg) were administered intraperitoneally, initated 3 days before the operation, continued at each three day and completed to a total of four doses. Flap viability ratios were evaluated at postoperative 7th day. According to these measurements, viable area ratios were found to be %28.6±6.9 in control, 59.2±3.8 in HBO, %66.3±5.9 in HBO + vitamin and %82.0±3.9 in vitamin group. Flap viability ratios were found higher for all treatment groups as compared with control (p<0.01). It may suggest that antioxidant vitamins E and C affected the flap viability exceptionally well, nevertheless positive effect of HBO remained relatively weak and let need for further investigation.

Keywords: Hyperbaric oxygen, Antioxidant vitamin, Skin flap

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