The effects of propofol use on ischemia- reperfusion injury in rat inferior epigastric skin island flap model

Background: Vascular insufficiency is the most frequently seen circulation problem following flap surgery procedures. İschemia begins to develop in tissue which is exposed to vascular insufficiency. Reperfusion begins after circulation returns to normal level as related to the duration of ischemia. At the same time ischemia-reperfusion injury occurs. The purpose of the this experimental study is to demonstrate the effects of propofol on skin flap ischemia-reperfusion injury during general anaesthesia.Material and Method: Thirty Sprague-Dawley male rats weighted between 250-300 gr are included in the study. Experiments were divided into three groups. The size of 3 x 6 cm island flap based on inferior epigastric artery was occured in all experiments. İschemia-reperfusion was not applied to rats in sham (I) group following flap elevation. In Control (II) and propofol (III) group, no flow ischemia for two hours and reperfusion for two hours was performed by clamping the inferior epigastric artery with a microclamp after flap elevation. 1 cc izotonic in group II and 5 mg/kg dose %1 propofol in group III was infused intravenously with the aim of tail vein catheterization. Heart rate, systolic artery pressure, partial oxygen pressure was measured in all experiments before surgical procedure and after reperfusion for two hours Flap survival rate of all groups was calculated on seventh day. On fourteenth day, samples taken from flap tissue were evaluated biochemically and histopathologically. MDA(malondialdehyde), SOD (superoxide dismutase), KAT (catalase), TAK(total antioxidant capacity, TOS (total oxidative stress), PON (paraoxonase) measurement was done for biochemical evaluation. Edema, inflammation, epithelial tissue, vascularisation and fibrosis was evaluated histopathologically.Results : In according to flap survival, There was statistically significant difference between propofol and control group (p<0,0001). When hemodynamic parameters were compared, there was no significant difference between groups in terms of heart rate. However disticntion of systolic arterial pressure and partial oxygen pressure between gorups was meaningful (p<0,0001). Biochemical investigastions showed that the values of MDA (p=0,016) and TOS (p=0,000) were found significantly low. Moreover values of SOD (p=0,000), TAC (p=0,000), CAT (p=0,03) was significantly high. There wasn?t significant difference between groups in terms of PON (p=0,862) value. In according to pathological evaluation, inflammation, edema and fibrozis signs were significantly decreased in I/R+propofol group when compared with I/R+izotonik. In the same way, epithelial regeneration was significantly increased in I/R+propofol group when compared with I/R+izotonik group.Conclusion : As a result, application of propofol in appropriate dose showed protective effect against ischemia-reperfusion damage in axial patterned skin flaps. For this reason, propofol may be preferred in operations which have risk of ischemia-reperfusion injury.Key words: İschemia-reperfusion injury, Propofol