Comparison the effect of perivascular and subcutis Botulinum Toxin Type A application on flap viability

Searching the substance which provides delay effect pharmacologically is still in progress. Few studies presence successful results on flap viability by BTx-A in gelişigüzel kanlanan and pedicled flaps to take place in literature. In this study BTx-A applied perivascular area, into the flap and both respectively. We investigatethe effect of BTx-A on flap viability and presence of differencesat varied application areas and the influence of mechanism and the possibilty to provide delay effect pharmacologically.Epigastric flap model was used in 42 rats and seperated into 7 groups. Group 1 (n=6) unipedicled flap was elevated and returned into same position in study day 3. Group 2 (n=6) in study day 0 perivascular saline injected and in study day 3 same surgical procedure was performed. Group 3 (n=6) same procedure was performed at group 2 but BTx-A injected as perivascular area instead of saline. Group 4 (n=6) saline injected into the flap only in study day 0 and in study day 3 same surgical procedure was performed. Group 5 (n=6) BTx-A injected into the flap only in study day 0 and same surgical procedure was performed in study day 3. Group 6 (n=6) saline injected into the flap and perivascular area both in study day 0 and same surgical procedure was performed in study day 3. Group 7 (n=6) BTx-A injected into the flap and perivascular area both in study day 0 and same surgical procedure was performed in study day 3.Blood stream velocity measured during surgery by laser doppler flowmeter. Sample obtained proximal and distal part of the flap for histological and biochemical assessment in study day 3.In the study day 10, flap necrosis rates measured photographically. Samples obtained proximal and distal part of the flap for histological and biochemical assessment. Also same time another sample obtained for genetical evaluation.When examine the findings at BTx-A applied groups we observed less flap necrosis in accordance with control groups. Additionally, genetical evaluation revealed increased i-NOS and VEGF gene expression levels, histological evaluation revealed increased count of vessels, PECAM and e-NOS immunostaining, biochemical evaluation revealed increased nitrite and nitrate quantity and laser doppler flowmetric blood stream velocity measurements increased.This values are statistically significant in BTx-A applied groups than controls.While BTx-A applied groups compared itself, group 3 and group 7 had less flap necrosis rates and more i-NOS and VEGF gene expression levels, count of vessels, blood stream velocity confirmed than group 5 .In the light of these findings BTx-A increased pediculated flap viability independently from application area. But we may dictate perivascular application of BTx-A has more positive effect on flap viability according to flap application. In combined(perivascular and flap) application such as group 7 has most positive effect on flap viability.This study demonstrates that BTx-A application provide delay effect pharmacologically by sympathectomy welded vasodilatation and stimulatory effect on angiogenesis.