The effect of amlodipin on ischemia-reperfusion injury in rat inferior epigastric artery skin island flap

ABSTRACT İntroduction: İschemia reperfusion (I / R) damage is one of the most important factors affecting flap viability in flap surgery, which is one of the main professions of Plastic Surgery. There are many studies investigating the negative effects of ischemia reperfusion damage in flaps and using different pharmacological agents. Protective effects of amlodipine, which is a calcium channel blockers, against ischemia reperfusion damage in tissues such as brain, heart and liver have been demonstrated. However, there are not enough studies about its effects against ischemia reperfusion damage in flaps. This study is planned with the hypothesis that Amlodipine, that has positive effects on ischemia reperfusion damage in different tissues, may also have such an effect on flaps. Material and Method: In our study, 24 female Sprague Dawley rats were used, each group consisting of 8 rats. Groups were divided as: Group I; sham, Group II; control (I / R) and Group III; treatment (I / R + Amlodipine). In the study, a 3x6 cm rat inferior epigastric artery skin island flap was used. After elevating the 6x3 cm inferior epigastric artery skin island flap in 8 rats of the sham group (Group I), flaps were resutured with 3/0 silk without application of ischemia and treatment. 8 hours of ischemia and 12 hours of reperfusion were applied in group II (control) and group III (treatment) . The 8 rats in the control group (Group II) were given 1cc isotonic solution by oral gavage for 7 days before surgery and 7 days after surgery. 5mg / kg / day Amlodipine (tablet form of the drug was crushed and mixed with isotonic solution) was administered to the treatment group (Group III) 7 days before and 7 days after the intervention. Twenty-one hour after intervention, for histopathological and biochemical analysis, two biopsies, 1x0.5 cm each, were taken from the middle 1/3 of the long axis of the flap from all rats. In all rats, live and necrotic areas were drawn on the seventh day after intervention on transparent acetate, which was drawn as 1 mm2 areas. The drawn areas were counted and survival rate of flaps was calculated as % by dividing the live area into the total flap area. Then the rats were sacrificed under general anesthesia (50 mg / kg ketamine hydrochloride + 10 mg / kg xylazine hydrochloride-intraperitoneal) by cervical dislocation. Results: Flap viability rates were significantly higher in the treatment (I / R + Amlodipine) group compared to the control (I / R) group (p <0.05). Neutrophil count (p = 0.021), MDA (p = 0.016) and MPO (p = 0.040) values in the treatment (I / R + Amlodipine) group were significantly lower than the control (I / R) group (p <0.05). No significant difference was found between the treatment and control groups in terms of vessel diameters (p = 0.141). Flap viability rates and vessel diameter were significantly higher in the sham group compared to the control group (I / R), while neutrophil count, MDA and MPO were significantly lower (p <0.05). In the sham group, flap viability rates were significantly higher (p <0.05), neutrophil count and MDA levels were significantly lower (p <0.05) compared to the treatment group (I / R + Amlodipine). No significant difference was found in terms of vessel diameters (p = 0.674) and MPO (p = 0.208) levels. When the three groups were compared in terms of vessel diameters, there was no difference between the groups (p = 0.081). Conclusion: As a result of the findings obtained from our study, it was concluded that Amlodipine, which is used for other purposes in clinical applications, may be effective in preventing ischemia-reperfusion damage in skin flaps. Keywords: Inferior epigastric artery skin island flap, Amlodipine, ischemia reperfusion