Botox usage effect on flap viability in rat perforator propeller flaps on posterior thigh

Usage of perforator and propeller flaps in tissue defect repairment is on the rise nowadays. Operation of these flaps requires experienced and meticulous surgery technique. In cases, where the vessels surrounding the flap, couldn't get detached clearly or where as the detachment is well, flap rotation issues can take place. Our research aims that, effects of botox into flap survival, after usage on posterior thigh perforator propeller flaps in rats. So that in these kind of patients, reconstruction of defect can be done with a propeller flap in the near site of defect, without the need for microsurgery anastomosis at the same time providing the protection of feeding arteries on donor site and determination of main feeding artery. Vessel spasm and thrombosis are the main causes of flap failure in lower extremity reconstruction surgery and also can be seen on perforative propeller flaps which are the alternatives of free flaps. In literature, effects of botulinum toxin are searched on flap viability and vessels. Botulinum toxin has effects on flap viability preventing vessel spasm. In our research, it is imposed on that botulinum toxin preventing effect on complications, after a reconstruction surgery done with propeller flaps. 20 rats are separated into two groups, 90 and 180 degrees rotated flaps randomly. Flaps are designed 2x2 cm sized from both sides of posterior thighs. 10 IU of botulinum toxin type A is used in injection to right biceps femoris muscle preoperatively and for infiltration underneath the flap (6 IU to muscle, 4 IU infiltrated). In control group, 1 ml saline is injected. After five days, its reached to flap feeding artery with the insicions on posterior superior of rigt thigh. Flaps are harvested, rotated 90 and 180 degrees clockwise, sutured into new position. Photos are shooted and it is evaluated for flap viabilty on 1, 3, 7th days, postoperatively. After 7th day, flap and its artery are excised, tissue necrosis, epidermal thickness, collagen density, granulation tissue, inflammatory cells and scar tissue are evaluated with hystological markers and stains (hematoxylin-eosin, VEGF, INOS). HE and Mallory Azan stained materials are evaluated with the modified Verhofstad scoring, for tissue wound, necrosis, edema, PMN infiltration, collagen density, vascularity, sebaceous glands. After scoring with the Verhofstad, means of scores are calculated. No significant statistical discrepancy is determined for necrosis in groups of 90 and 180 degree rotated flaps on right sides (p>0,05). 90 and 180 degrees rotated left sided flaps were statistically significant (p<0,05). Edema and PMN infiltration results were not statistically significant on 90 and 180 degrees rotated left sided flaps ( p>0,05). Collagen density, were not statistically significant on 90 and 180 degrees rotated right sided flaps (p>0,05) but on 90 and 180 degrees rotated left sided flaps were statistically significant (p<0,05). Hair root density 90 and 180 degrees rotated right sided flaps were statistically significant than other 2 groups (p<0,05). There was no difference between the groups of 90 and 180 degrees left sides statistically (p>0,05). Vascularity was statistically significant on 90 and 180 degrees rotated right (p<0,05). Epidermis tissues stained Mallory Azan are calculated from all groups by two different hystologists. Mains are calculated. 90 degrees left, 90 degrees right and 180 degrees right were not statistically significant (p>0,05). 180 degrees rotated left group epidermal tissue was statistically significant (p<0,05). With these findings, preoperatively botulinum toxin usage is found useful before propeller flap surgery, for preventing complications and helping wound healing, rather than group where botulinum toxin is not used. We reached to a conclusion that botulinum toxin can be used before flap surgery for protection of flaps.