The effects of ıschemia-reperfusion ınjury and epidural/spinal anaesthesia on transvers rectus abdominis musculocutaneous flap

Background: In microsurgical procedures, the choice of appropriate anaesthetic technique is important for providing surgical success. The purpose of this experimental study is to compare spinal and epidural anaesthesia on the rat TRAM flap model which is denotative of experimental muscle flap transfer ischemiareperfusion injury.Method: Fourty male Sprague-Dawley rat was divided into 4 experimental groups containing 10 animal each. Animals were divided into Group I (Sham, n=10), group II (I/R, spinal anaesthesia, n=10), Group III (I/R, Epidural anaesthesia, n=10) and Group IV (I/R, control, n=10). TRAM musculocutaneous flap was occured in all groups. At the end of the surgery; hyalinization, nuclear changes and inflammation rates for histopathological evaluation and total antioksidan state (TAS), total oxidative stress (TOS), malonyldialdehyde (MDA), nitric oxide (NO), paraxonase (PON) measurements for biochemical evaluation were evaluated on tissue samples obtained from muscle tissue.Results: Biochemical investigations showed that MDA level was significantly lower in epidural group when compared with I/R group and PON level was significantly higher in epidural group when compared with I/R group (p:0.037, p:0.028). TOS level significantly increased in spinal group when compared with epidural group and in I/R group when compared with epidural group (p:0,045; p:0,001). In epidural group, TAS level was significantly higher than spinal, I/R groups (p:0,001; p:0,001). There was no significant difference between of groups in terms of NO level (p>0.05). Pathological evaluation showed that minimal inflammation findings were significantly higher in spinal group comparing with epidural group (p:0.001). Nuclear change rate was significantly higher in spinal group when compared with I/R and epidural group (p<0.01). There was no significant difference between groups in terms of hyalinisation (p>0.05).Conclusion: In the presented study, MDA level, basic derivative of lipid peroxidation; and oxidative stress significantly decreased in epidural anaesthesia. In other words, epidural anaesthesia provide more efficient free radical scavenger by increasing total antioxidant capacity. Histopathologically, nuclear migration to center, hyalinization wtih globuler changes, degeneration of fibers and inflammation is seen during I/R injury. Our findings indicate that epidural anaesthesia can be considered as a suitable choice of anaesthetic method for decreasing ischemia reperfusion injury of muscle flaps.