Ratlarda abdominal deri ada flebinde Botulinum Toksin-A ile kimyasal geciktirme uygulamasının flep yaşayabilirliği üzerine etkisi

INTRODUCTION: Repair of wide soft tissue defects is a major challenge in Plastic and Reconstructive Surgery and the proper method for reconstruction is still under investigation. The main problem after large flap transfer is distal necrosis and many experimental and clinical methods have been used for the prevention of distal necrosis on flaps. One of the most effective and accepted methods is the utilization of surgical delay on flap. As surgical delay requires an additional surgical intervention before the main operation, recent studies have been concentrated on the delay of flaps with chemical agents. For this purpose different chemical agents have been tested, but yet there is no agreement on any of the agent that is definitely effective. This study was performed to investigate the effect of botulinum toxin A as a chemical delay agent on the survival of skin island flapsMATERIALS AND METHODS: In this study, 30 male Sprague-Dawley rat weighing between 250-300 gr. were used. The rats were divided into three groups, 10 rats in each. In group 1, no chemical delay was performed and this group served as control. In Group 2 %0.9 NaCl and in Group 3 botulinum toxin-A was used for chemical delay. Seven days after chemical delay, the rats in all groups were operated and abdominal skin island flaps measuring 7x7 cm were raised based on right superficial inferior epigastric artery. All the flaps were resutured to their places just after flap elevation and fluorescein angiography was performed to find the fluoresceined area in the flap. The rats were followed for 7 days and sacrificed. The surviving area was measured using planimetric technique. Tissue samples were obtained for histopathological and biochemical evaluation. The vessel count was performed histopathologically and tissue VEGF (Vascular endothelial growth factor) levels were tested biochemically.RESULTS: The mean fluoresceined area were 37.5± 4.2 % in control group, 44.4 ± 1.3 % in Group 2 and 66.0±5.5 % in Group 3. The surviving area in the flap were 57.2 ± 4.8% in control group,72.1 ± 1.6 % in Group 2 and 93.3 ± 3.5 % in Group 3. The mean tissue VEGF levels were 2820,7 pg/g prt in control group, 3036,2 pg/g prt in Group 2 and 6283,3 pg/g prt in Group 3. Mean vessel numbers were 15.52 ± 3.6 in control group, 22.65 ± 3.6 in Group 2 and 26.01± 3.6 in Group 3. In all evaluation parameters, the values were statistically higher in rats with delay using botulinum toksin-A compared to other two groups (p<0.05)CONCLUSION: In this study we found that flap survival was increased after using chemical delay with botulinum toxin-A. As the application of botulinum toxin-A is easy and obviates the need for additional surgery and requirement of special technique and equipment, we think that this agent can be used in clinical practice for enhancing flap survival.