Evaluation of the effect of autologous dermis graft on rat achilles tendon healing

Introduction: Tendon injuries occupy an important place among the reasons for applying to the emergency department in daily life. The Achilles tendon is one of the most commonly injured tendons. Especially in young-middle-aged individuals, its incidence is higher in individuals who are active in sports. After the tendon repair is performed surgically, adverse conditions such as rupture (re-rupture) are encountered in the patient follow-ups. In such cases, negative situations can occur, from the need for reoperation to permanent disability. This result seriously affects the career of the athlete, especially with the late return to work in Achilles ruptures in athletes. Various methods have been tried in the literature to strengthen the Achilles tendon, which is problematic to heal due to insufficient perfusion. For tendon strengthening; Plantaris tendon graft, fascial flaps, synthetic grafts, various biological materials (acellular dermal matrix) were used. In addition, various injections (stem cell, PRP, autologous serum, growth factors, hydrogels, etc.) were made to the repair site to strengthen tendon healing. Despite a detailed literature review, we could not find any data on dermis graft used for tendon augmentation. Dermis grafts; It can be an alternative because it is easily accessible, cheap in cost, has less foreign body reaction because it is the core tissue, can be removed in a shorter time and causes less donor site morbidity. The aim of our study is to determine the effectiveness of autologous dermis graft on healing in order to strengthen tendon healing in Achilles tendon injuries, to reduce the risk of re-rupture and to obtain a strong healing. Material and Method:In our study, 20 male Sprague Dawley rats, 2-3 months old, weighing 300-350 g, were used. Rats were randomly divided into two groups. An atraumatic, full-thickness, straight incision was made in the right Achilles tendon of both groups. The rats in the first group are the control group; After the tendon repair was performed, no application was made to the repair area. After the tendon repair was performed on the rats in the experimental group in the second group; The dermis graft taken from the back was wrapped around the tendon repair area and sutured. Samples taken after the rats were sacrificed at the end of the 4-week follow-up; evaluated for histopathological examination (with semiquantitative Movin and Bonar scores), immunohistochemical examination (for type I and type III collagen density), and biomechanical studies. P<0.05 was accepted as the statistical significance limit. Results:In all samples, the tendon was intact, no rupture was observed. In terms of histological parameters, significant results were observed in the experimental group repaired with dermis graft (p<0.05). In immunohistochemical examination, type I collagen and type I/type III collagen density were observed more in the experimental group. In the biomechanical examinations, statistically significant results were obtained in the experimental group (p<0.05). Conclusion:As a result of the findings obtained from the study, it was shown that dermis graft can contribute positively to the healing process after Achilles tendon injury in rats. Tendon repair with dermis graft; It can be a good alternative to other methods for tendon augmentation or strengthening. Larger studies are needed for clinical use of this technique.