The effect of sugammadexin on flap perfusion and viability in flaps with random circulation pattern in rats

Background: Flap surgery is the most important treatment method of Plastic Reconstructive and Aesthetic Surgery. The most devastating complication in flap surgery is necrosis due to tissue ischemia. Parameters that increase and decrease tissue necrosis have been investigated in many experimental studies. Sugammadex is a chemical agent that has entered the practice of anesthesia relatively recently. The main function of sugammadex is to restore the muscle relaxation state provided by other drugs during surgical operations and to end the patient's muscle paralysis state. Indocyanine green angiography based on fluorescent imaging has started to be used in the 21st century. Indocyanine green dye is used in this method, which enables the evaluation of flap perfusion in the intraoperative and postoperative periods. In this experimental study, the effect of sugammadex on flap perfusion and viability in random based dorsal flaps was investigated. Methodology: In this study, 36 rats were used. The study was designed as randomized, double blind experiment in such a way that animals were divided into three groups as experimental group, positive control group and negative control group. A jugular catheter was applied preoperatively in order to administer drugs and indocyanine dye intravenously to all rats. On the day of the experiment, standardized 9 x 3 cm dorsal flaps with caudal pedicles were raised from the back area of the subjects, aluminum foils of suitable sizes were placed under the flaps as a background, and then the flaps were sutured back to their original places with a similar number of silk sutures in each subject. Then, sugammadex at a dose of 100 mg/kg was administered intravenously to the rats in the experimental group, and neostigmine was administered at a dose of 0,1 mg/kg intravenously to the rats in the positive control group. The same volume of saline solution was administered intravenously to the negative control group. The drugs to be used in the experimental setup were administered to the subjects once in total, before the 0th-minute measurement. Subsequently, the perfusion of the flaps was evaluated using indocyanine green angiography at the 0th minute, 20th minute, 30th minute, and 7th day from the initial time of administration of the drugs. Photographs of all flaps were obtained using the camera on the 7th day. Then, all images of all groups obtained by camera and indocyanine green angiography were examined and necrosis calculations were made using the Image J v1.0 program. In addition, fluorescence intensities, fluorescence filling rates, and flow rates of the flaps in the dorsal flaps were also examined using the SPY device and SPY-Q program. All flaps were completely excised with wide margins and sent for histopathological examination, following the euthanasia after the 7th-day measurements. Results: In this study, ulcer, necrosis, PMNL, MNCI, edema, collagen density, fibroblast proliferation, and neovascular density levels were similar in all three groups, and the differences between the groups were not statistically significant. In this regard, in the general evaluation, it is seen that the negative control group given sugammadex SF and the positive control group given neostigmine have similar effects on dorsal flap tissue histopathology. There was no significant difference between the negative control, the positive control and the experimental groups in terms of maximum filling rates and maximum filling rate percentages, fifth second rates, Ingress, Ingress rate and Ingress rate percentages, SPY Necrosis Values and photographic necrosis values (p>0.05). Conclusion: It cannot be said that sugammadex has a negative effect on flap histopathology. However, since a single and fixed dose of sugammadex was used in this study, no interpretation of dose-dependent toxicity can be made. The differences between the control, neostigmine, and sugammadex groups were not significant at 0th minutes, 20th minutes, 30th minutes, and 7th days, indicating that sugammadex did not cause any damage to the structure of the tissues or to the blood circulation of the dorsal flaps. Therefore, sugammadex is safe for use in flap surgery. Keywords: dorsal flap, indocyanine green, necrosis, neostigmine, sugammadex