Comparison of synergistic effects of alpha lipoic acid and l-carnitine over classic methods on flap viability increasement.

Reconstructive surgery is one of the basic elements of plastic surgery. Reconstructive surgery describes the process of reconstruction of a lost tissue with a similar tissue. At this point, the common idea of ​​all plastic surgeons is to repair the lost tissue using the closest tissues in terms of function and tissue properties. One of the biggest problems in the repair of tissue defects with flaps is the unpredictable loss of flaps prepared to close the defect area. Various methods have been proposed to prevent or minimize these losses, but a common idea that could be considered as the gold standard has not been reached. The use of antioxidant agents for the prevention of damage caused by oxygen radicals has been investigated for the prevention of degeneration caused by ischemia- based diseases in neurology, the recovery of intestinal vascular occlusions in general surgery, and infertility treatment in urology. However, the use of antioxidants to prevent loss of blood circulation in skin flaps is not a topic often investigated. The aim of our study was to investigate the possible positive effects of flap viability after local injection of strong antioxidant agents l-carnitine and alpha lipoic acid (ALA) to prevent oxygen radical damage to Mcfarlane flaps. In this study, 49 female, adult, 250 - 350 g Wistar Albino rats were used. The subjects were divided into 7 groups as control, delay-1, delay-2, antioxidant -1, antioxidant - s, prp - 1 and prp - s. In delay - 1 and delay - 2 groups flaps that were designed on the back of rats as Mcfarlane flaps but two longitudinal full-thickness incisions including of the panniculus carnosus were made and the flaps were not separated from their base. After waiting for 1 week, the Mcfarlane flaps on the backs of all groups with the other groups were lifted and returned to their places, including panniculus carnosus. Subsequently, PRP - 1 and PRP - S groups' flaps were injected, antioxidant - 1 and antioxidant - s groups' flaps were injected with 200 mg / kg l - carnitine and 100 mg / kg alphalipoic. Delay - 1 and delay - 2 groups were not injected. Additionally, in PRP - s, antioxidant - s and delay - 2 groups silicone sheets were placed on the flap bases and flaps were prevented from vascularization. Rats were followed up on days 1, 3 and 7, and sacrificed at the end of day 7, and photographed for macroscopic evaluation. For the histopathological evaluation, full - thickness skin biopsies with a diameter of 1.5 cm were taken from the healthy tissue - necrosis transition areas of the flaps. In biopsies, inflammatory cell, fibroblast and collagen concentrations were measured by hematoxylin eosin and masson trichrome staining. In addition, vascular endothelial growth factor (VEGF) immunostaining was performed to detect neoangiogenesis. One subject per prp - 1 and prp - s groups was lost during the study. The other subjects tolerated the study well. The ratio of living flap area to total flap area was made with AutoCad and Photoshop programs. All data were evaluated statistically. There was a statistically significant increase in the living flap area in delay treated and antioxidant injected groups compared to the control group. There was no statistical difference in PRP groups. Surgical delay method is still the most frequently used and the most successful method to improve flap viability. However, the need for a two-stage operation, infection, pain, need for routine dressing after the first operation, long follow-up, and inability to use in acute situations are the disadvantages. ALA and L- carnitine may be widely used because of their ease of application, easy availability, no need for additional surgery and reliability. In this study, ALA and L-carnitine have been shown to increase flap viability in flap models with random patterned blood circulation.