Öz
Introduction: Random pattern skin flaps are used frequently for the reconstruction of random patern skin defects from various causes in plastic and reconstructive surgery. Most frequent complication with these flaps is the necrosis of distal parts due to inadequate blood supply. Various types of techniques have been defined to avoid and reduce flap loss. The aim of this study is to first time evaluate the effect of concentrate growth factor (CGF), which is derived from whole blood and is rich in growth factors, on the survival of random pattern skin flaps.
Material and Method: Fifty Sprague-Dawley rats were used for the study. Forty of them were used for the experiment group and ten for the preparation of CGF. Distal based 3x9 cm Mcfarlene flaps were elevated from the back of the rats and in CGF group (n:20), CGF matrix was placed before closure. The control group (n:20) did not get any treatment. On postoperative day 7, the flaps were evaluated by photographic, scintigraphic, and histopathological methods.
Results: The median rate of surviving flap areas in control group was 53% (47-58). In CGF group the median rate of flap viability was %58 (55-64). The higher flap viability rates obtained from CGF applied group was found to be statistically significantly higher from control group (p<0,001). For the scintigraphic perfusion area evaluations, the median rate of flap perfusion was 54% (51-60) for the control group and 61% (59-64) for the CGF group. The higher flap perfusion rates obtained from CGF applied group was found to be statistically significantly higher from control group (p=0,001). The median rate of vascularity scores in CGF treated group was 10,0 (8,25-11,75) and 7,5(6,25-9,00) in control group. The difference was found to be statistically significantly higher in the study group (p=0,003). Inflammation scores were not found to be statistically significantly different (p=0,246).
Conclusions: This study shows that locally applied CGF under skin flap increases flap viability which might be associated with the increase in angiogenesis. This study for the first time shows that in flap surgery, applying CGF which is rich in growth factors, might have favourable effects on the flaps that are prone to ischemia but further studies are needed.
Anahtar Kelimeler
Kaynakça
- 1. Li W, Enomoto M, Ukegawa M, et al. Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg. 2012;129(4):858-66.
- 2. Gursoy K, Teymur H, Koca G, et al. The Effect of Astaxanthin on Random Pattern Skin Flaps. Ann Plast Surg. 2020;84(2):208-15.
- 3. Liu PY, Wang XT, Badiavas E, Rieger-Christ K, Tang JB, Summerhayes I. Enhancement of ischemic flap survival by prefabrication with transfer of exogenous PDGF gene. J Reconstr Microsurg. 2005;21(4):273-9.
- 4. Wang SP, Lan ZY, Xia W, et al. The effects of vasonatrin peptide on random pattern skin flap survival. Ann Plast Surg. 2014;72(1):94-9.
- 5. Huang N, Ashrafpour H, Levine RH, et al. Vasorelaxation effect and mechanism of action of vascular endothelial growth factor-165 in isolated perfused human skin flaps. J Surg Res. 2012;172(1):177-86.
- 6. Fayazzadeh E, Yavarifar H, Rafie SR, Motamed S, Sotoudeh Anvari M, Boroumand MA. Fibroblast Growth Factor-1 vs. Fibroblast Growth Factor-2 in Ischemic Skin Flap Survival in a Rat Animal Model. World J Plast Surg. 2016;5(3):274-9.
- 7. Schein O, Westreich M, Shalom A. Effect of intradermal human recombinant copper-zinc superoxide dismutase on random pattern flaps in rats. Head Neck. 2013;35(9):1265-8.
- 8. Orhan E, Uysal AC, Baser E, Keskin D, Demiroglu-Yakut C. The effect of intradermal administration of inactive platelet-rich plasma on flap viability in rats. Acta Cir Bras. 2017;32(4):280-6.
- 9. Findikcioglu F, Findikcioglu K, Yavuzer R, Lortlar N, Atabay K. Effect of preoperative subcutaneous platelet-rich plasma and fibrin glue application on skin flap survival. Aesthetic Plast Surg. 2012;36(5):1246-53.
- 10. Wang B, Geng Q, Hu J, Shao J, Ruan J, Zheng J. Platelet-rich plasma reduces skin flap inflammatory cells infiltration and improves survival rates through induction of angiogenesis: An experiment in rabbits. J Plast Surg Hand Surg. 2016;50(4):239-45.
- 11. Chai J, Ge J, Zou J. Effect of Autologous Platelet-Rich Plasma Gel on Skin Flap Survival. Med Sci Monit. 2019;25:1611-20.
- 12. Bonazza V, Hajistilly C, Patel D, et al. Growth Factors Release From Concentrated Growth Factors: Effect of beta-Tricalcium Phosphate Addition. J Craniofac Surg. 2018;29(8):2291-5.
- 13. Kim HY, Park JH, Han YS, Kim H. The effect of platelet-rich plasma on flap survival in random extension of an axial pattern flap in rabbits. Plast Reconstr Surg. 2013;132(1):85-92.
- 14. Takikawa M, Sumi Y, Ishihara M, et al. PRP&F/P MPs improved survival of dorsal paired pedicle skin flaps in rats. J Surg Res. 2011;170(1):e189-96.
- 15. Rodella LF, Favero G, Boninsegna R, et al. Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction. Microsc Res Tech. 2011;74(8):772-7.
- 16. Yu M, Wang X, Liu Y, Qiao J. Cytokine release kinetics of concentrated growth factors in different scaffolds. Clin Oral Investig. 2019;23(4):1663-71.
- 17. Wang F, Sun Y, He D, Wang L. Effect of Concentrated Growth Factors on the Repair of the Goat Temporomandibular Joint. J Oral Maxillofac Surg. 2017;75(3):498-507.
- 18. Topkara A, Ozkan A, Ozcan RH, Oksuz M, Akbulut M. Effect of Concentrated Growth Factor on Survival of Diced Cartilage Graft. Aesthet Surg J. 2016;36(10):1176-87.
- 19. Zhao QM, Gao J, Huang XX, Chen XP, Wang X. Concentrated Growth Factors Extracted from Blood Plasma Used to Repair Nasal Septal Mucosal Defect After Rhinoplasty. Aesthetic Plast Surg. 2019.
- 20. Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S. The use of platelet-rich plasma in plastic surgery: a systematic review. J Plast Reconstr Aesthet Surg. 2013;66(3):301-11.
- 21. Rah DK, Min HJ, Kim YW, Cheon YW. Effect of Platelet-Rich Plasma on Ischemia-Reperfusion Injury in a Skin Flap Mouse Model. Int J Med Sci. 2017;14(9):829-39.
- 22. Hong S, Chen W, Jiang B. A Comparative Evaluation of Concentrated Growth Factor and Platelet-rich Fibrin on the Proliferation, Migration, and Differentiation of Human Stem Cells of the Apical Papilla. J Endod. 2018;44(6):977-83.
- 23. Hu Y, Jiang Y, Wang M, Tian W, Wang H. Concentrated Growth Factor Enhanced Fat Graft Survival: A Comparative Study. Dermatol Surg. 2018;44(7):976-84.
- 24. Park HC, Kim SG, Oh JS, et al. Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs: A Comparative Study. Implant Dent. 2016;25(3):387-93.
- 25. Masuki H, Okudera T, Watanebe T, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent. 2016;2(1):19.
- 26. Baris R, Kankaya Y, Ozer K, et al. The effect of microneedling with a roller device on the viability of random skin flaps in rats. Plast Reconstr Surg. 2013;131(5):1024-34.
- 27. Kizilaslan S, Karabuda ZC, Olgac V. The Effect of Concentrated Growth Factor on Calvarial Bone in Diabetic Healing. J Craniofac Surg. 2020;31(1):158-61.
Konsantre büyüme faktörünün random patern cilt flep yaşayabilirliği üzerine etkisi: deneysel çalışma
Öz
Giriş: Plastik ve rekonstrüktif cerrahide, random patern cilt flepleri çeşitli nedenlerle oluşan doku defektlerinin onarımında sıklıkla kullanılmaktadır. Bu tür fleplerde en sık karşılaşılan sorun yetersiz kan akımına bağlı flep distalinde görülen iskemik nekrozdur. Flep kayıplarını ortadan kaldırmak ve azaltmak için çok sayıda teknik tanımlanmıştır. Bu çalışmadaki amacımız tam kandan elde edilen ve büyüme faktörleri açısından zengin olan konsantre büyüme faktörünün (CGF) daha önce çalışılmamış olan random patern cilt flep yaşayabilirliği üzerine etkisini incelemektir.
Gereç ve Yöntem: Çalışmada 50 adet Spraque –Dawley cinsi sıçan kullanıldı. Sıçanların 40 tanesi deney için, 10 tanesi CGF elde etmek için kullanıldı. Sıçanların sırt bölgelerinden kaldırılan 3x9 cm’lik distal bazlı McFarlene fleplerinin altına çalışma grubunda (n:20) CGF matriks yerleştirildi. Kontrol grubunda (n:20) herhangi bir tedavi uygulanmadı. İşlem sonrası 7. günde değerlendirme için fotoğrafik, sintigrafik ve histopatolojik inceleme yapıldı.
Bulgular: Alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %53 (47-58) olarak bulundu. CGF uygulanan grupta ise flep viabilite ortanca oranı %58 (55-64) olarak bulundu. CGF grubunda elde edilen yüksek flep yaşayabilirlik oranları istatistiksel olarak anlamlı bulundu (p<0,001). Sintigrafik perfüzyon alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %54 (51-60) iken bu değer CGF uygulanan grupta %61 (59-64)’di. Elde edilen artış istatistiksel olarak anlamlı bulundu (p=0,001). Histopatolojik değerlendirme sonucunda çalışma grubunda elde edilen vaskülarite skorlarının ortanca değerlerinin (10,0 (8,25-11,75)) kontrol grubuna (7,5(6,25-9,00)) göre fazla olduğu görüldü ve bu fark istatistiksel olarak anlamlı bulundu (p=0,003). İnflamasyon skorları açısından gruplar arasında anlamlı farklılık saptanmadı (p=0,246).
Sonuç: Bu çalışmanın sonuçları lokal olarak flep altına uygulanan konsantre büyüme faktörünün flep yaşayabilirliğini artırdığını ve bu etkinin anjiogenez ile ilişkili olabileceği gösterilmiştir ancak bu konuda ileri çalışmalara ihtiyaç vardır. Flep cerrahisinde, iskemi öngörülen durumlarda büyüme faktörlerinden zengin CGF’in uygulanmasının flep yaşayabilirliği üzerine olumlu etkileri olacaktır.
Anahtar Kelimeler
Konsantre Büyüme Faktörü CGF Cilt Flebi Flep Yaşayabilirliği
Kaynakça
- 1. Li W, Enomoto M, Ukegawa M, et al. Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg. 2012;129(4):858-66.
- 2. Gursoy K, Teymur H, Koca G, et al. The Effect of Astaxanthin on Random Pattern Skin Flaps. Ann Plast Surg. 2020;84(2):208-15.
- 3. Liu PY, Wang XT, Badiavas E, Rieger-Christ K, Tang JB, Summerhayes I. Enhancement of ischemic flap survival by prefabrication with transfer of exogenous PDGF gene. J Reconstr Microsurg. 2005;21(4):273-9.
- 4. Wang SP, Lan ZY, Xia W, et al. The effects of vasonatrin peptide on random pattern skin flap survival. Ann Plast Surg. 2014;72(1):94-9.
- 5. Huang N, Ashrafpour H, Levine RH, et al. Vasorelaxation effect and mechanism of action of vascular endothelial growth factor-165 in isolated perfused human skin flaps. J Surg Res. 2012;172(1):177-86.
- 6. Fayazzadeh E, Yavarifar H, Rafie SR, Motamed S, Sotoudeh Anvari M, Boroumand MA. Fibroblast Growth Factor-1 vs. Fibroblast Growth Factor-2 in Ischemic Skin Flap Survival in a Rat Animal Model. World J Plast Surg. 2016;5(3):274-9.
- 7. Schein O, Westreich M, Shalom A. Effect of intradermal human recombinant copper-zinc superoxide dismutase on random pattern flaps in rats. Head Neck. 2013;35(9):1265-8.
- 8. Orhan E, Uysal AC, Baser E, Keskin D, Demiroglu-Yakut C. The effect of intradermal administration of inactive platelet-rich plasma on flap viability in rats. Acta Cir Bras. 2017;32(4):280-6.
- 9. Findikcioglu F, Findikcioglu K, Yavuzer R, Lortlar N, Atabay K. Effect of preoperative subcutaneous platelet-rich plasma and fibrin glue application on skin flap survival. Aesthetic Plast Surg. 2012;36(5):1246-53.
- 10. Wang B, Geng Q, Hu J, Shao J, Ruan J, Zheng J. Platelet-rich plasma reduces skin flap inflammatory cells infiltration and improves survival rates through induction of angiogenesis: An experiment in rabbits. J Plast Surg Hand Surg. 2016;50(4):239-45.
- 11. Chai J, Ge J, Zou J. Effect of Autologous Platelet-Rich Plasma Gel on Skin Flap Survival. Med Sci Monit. 2019;25:1611-20.
- 12. Bonazza V, Hajistilly C, Patel D, et al. Growth Factors Release From Concentrated Growth Factors: Effect of beta-Tricalcium Phosphate Addition. J Craniofac Surg. 2018;29(8):2291-5.
- 13. Kim HY, Park JH, Han YS, Kim H. The effect of platelet-rich plasma on flap survival in random extension of an axial pattern flap in rabbits. Plast Reconstr Surg. 2013;132(1):85-92.
- 14. Takikawa M, Sumi Y, Ishihara M, et al. PRP&F/P MPs improved survival of dorsal paired pedicle skin flaps in rats. J Surg Res. 2011;170(1):e189-96.
- 15. Rodella LF, Favero G, Boninsegna R, et al. Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction. Microsc Res Tech. 2011;74(8):772-7.
- 16. Yu M, Wang X, Liu Y, Qiao J. Cytokine release kinetics of concentrated growth factors in different scaffolds. Clin Oral Investig. 2019;23(4):1663-71.
- 17. Wang F, Sun Y, He D, Wang L. Effect of Concentrated Growth Factors on the Repair of the Goat Temporomandibular Joint. J Oral Maxillofac Surg. 2017;75(3):498-507.
- 18. Topkara A, Ozkan A, Ozcan RH, Oksuz M, Akbulut M. Effect of Concentrated Growth Factor on Survival of Diced Cartilage Graft. Aesthet Surg J. 2016;36(10):1176-87.
- 19. Zhao QM, Gao J, Huang XX, Chen XP, Wang X. Concentrated Growth Factors Extracted from Blood Plasma Used to Repair Nasal Septal Mucosal Defect After Rhinoplasty. Aesthetic Plast Surg. 2019.
- 20. Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S. The use of platelet-rich plasma in plastic surgery: a systematic review. J Plast Reconstr Aesthet Surg. 2013;66(3):301-11.
- 21. Rah DK, Min HJ, Kim YW, Cheon YW. Effect of Platelet-Rich Plasma on Ischemia-Reperfusion Injury in a Skin Flap Mouse Model. Int J Med Sci. 2017;14(9):829-39.
- 22. Hong S, Chen W, Jiang B. A Comparative Evaluation of Concentrated Growth Factor and Platelet-rich Fibrin on the Proliferation, Migration, and Differentiation of Human Stem Cells of the Apical Papilla. J Endod. 2018;44(6):977-83.
- 23. Hu Y, Jiang Y, Wang M, Tian W, Wang H. Concentrated Growth Factor Enhanced Fat Graft Survival: A Comparative Study. Dermatol Surg. 2018;44(7):976-84.
- 24. Park HC, Kim SG, Oh JS, et al. Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs: A Comparative Study. Implant Dent. 2016;25(3):387-93.
- 25. Masuki H, Okudera T, Watanebe T, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent. 2016;2(1):19.
- 26. Baris R, Kankaya Y, Ozer K, et al. The effect of microneedling with a roller device on the viability of random skin flaps in rats. Plast Reconstr Surg. 2013;131(5):1024-34.
- 27. Kizilaslan S, Karabuda ZC, Olgac V. The Effect of Concentrated Growth Factor on Calvarial Bone in Diabetic Healing. J Craniofac Surg. 2020;31(1):158-61.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 3 Sayı: 2 |
Üniversitelerarası Kurul (ÜAK) Eşdeğerliği: Ulakbim TR Dizin'de olan dergilerde yayımlanan makale [10 PUAN] ve 1a, b, c hariç uluslararası indekslerde (1d) olan dergilerde yayımlanan makale [5 PUAN]
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Not: Dergimiz WOS indeksli değildir ve bu nedenle Q olarak sınıflandırılmamıştır.
Yüksek Öğretim Kurumu (YÖK) kriterlerine göre yağmacı/şüpheli dergiler hakkındaki kararları ile yazar aydınlatma metni ve dergi ücretlendirme politikasını tarayıcınızdan indirebilirsiniz. https://dergipark.org.tr/tr/journal/2316/file/4905/show
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