Ultrason ile ön koşullamanın ratlarda random patern deri flep yaşamı üzerine etkileri
Effect of preconditioning by ultrasound on flap vi̇abi̇li̇ty in rat random patern flap model
Yazar: SERCAN YÜCEL
Danışman: PROF. DR. GALİP KEMALİ GÜNAY
Erciyes Üniversitesi / Tıp Fakültesi / Plastik Rekonstrüktif ve Estetik Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2016
Konu: Plastik ve Rekonstrüktif Cerrahi = Plastic and Reconstructive Surgery
Dizin: Anjiyografi = Angiography ; Cerrahi flepler = Surgical flaps ; Cerrahi işlemler-operatif = Surgical procedures-operative ; Cerrahi-plastik = Surgery-plastic ; Sıçanlar = Rats ; Ultrasonografi = Ultrasonography

Özet:
Introduction and Purpose: Surgical delay is a historically important procedure but getting less popular after the evolution of better techniques for musculocutaneous, fasciacutaneous and free flaps. Therefore the usage of this technique became limited for random and axial pattern flaps. Free flap failure rate ranges between 4-13% in qualified centers, despite the selection of the patients, innovations of microsurgery, preperation of recipient site and donor area. Lately anatomical studies define the flap designs and angiosomes but it couldnt prevent the flap failure as a reconstructive surgery problem. In this experimental study, ultrasound assisted flap delay technique compared with surgical delay procedure and topographical, histological, biochemical and microangiographic evaluation performed of flap survival.
Materials and Methods: This study included 4 months old 98 male Sprague Dawley rats range between 300-450 grams. They divided into 8 groups consisting of 11 animals in each group. Remaining 10 animals used for biochemical analysis of VEGF rate with the biopsies of 3th day for surgical delay technique performed rats. In this study 1st group as control, 2nd group as surgical delay, 3th group as postoperative ultrasound treatment, 4th group as postoperative ultrasound sham, 5th group as preoperative ultrasound treatment, 6th group as preoperative ultrasound sham, 7th group as pre and postoperative ultrasound treatment, 8th group as pre and postoperative ultrasound sham has been selected. McFalene flap model with the dimensions of 2x8 cm has been performed to the animals. Flap vitality rate has been evaluated after the 14th day of flap elevation. Tissue VEGF rate measured for all animals. Total vessel count and flap vitality rate determined. Additionally one animal choosed for each group for imaging of flap vascularity with microangioagraphy. Statistical analysis has been performed and compared with the obtained datas.
Results: Flap vitality rate in control group was %38.75±3.8, in surgical delay group was %76.6±3.3, in postoperative ultrasound treatment group was  %61.29, ±3.6, in postoperative ultrasound sham group was %42.05±5.8, in preoperative ultrasound treatment group was %68.6±2.9, in preoperative ultrasound sham group was %45.5±4.1, in pre and postoperative ultrasound treatment group was %79.7±2.7, in pre and postoperative ultrasound sham group was %47.5±5.5. Tissue VEGF rate in control group was 729.37 pg/ml/gr, in surgical delay group was 2214.06 pg/ml/gr, in postoperative ultrasound treatment group was 3164.64 pg/ml/gr, in postoperative ultrasound sham group was 1383.13 pg/ml/gr, in preoperative ultrasound treatment group was 2197.51  pg/ml/gr, in preoperative ultrasound sham group was 927.83 pg/ml/gr, in pre and postoperative ultrasound treatment group was 2827.21 pg/ml/gr, in pre and postoperative ultrasound sham group was 1111.58 pg/ml/gr.
Microangiographic visualization showed that flaps nourished in multiple places with more and larger vessels in surgical delay and pre and postoperative ultrasound treatment groups compared to other groups.  Increased vascularity rate in microangiographic evaluation in postoperative ultrasound treatment group and preoperative ultrasound treatment group compared to control group and other ultrasound sham groups detected in statistically significant fashion. Vascularity ranking for all groups obtained as; surgical delay ≥ pre and postoperative ultrasound treatment group > preoperative ultrasound treatment group ≥ postoperative ultrasound treatment group > pre and postoperative ultrasound sham group > preoperative ultrasound sham group ≥ postoperative ultrasound sham group > control group.
Vascular count in1 mm2  with the biopsies taken after the surgical procedure in control group was 24,2/mm2, in surgical delay group was 26,9/mm2, in postoperative ultrasound treatment group was  25,2/mm2, in postoperative ultrasound sham group was 24,5/mm2, in preoperative ultrasound treatment group was 26,1/mm2, in preoperative ultrasound sham group was 24,9/mm2, in pre and postoperative ultrasound treatment group was 27,2/mm2, in pre and postoperative ultrasound sham group was 25,1/mm2.
Conclusion: Ultrasound is an ideal method to increase flap vitality as performing before or after the flap elevation. Combining application of the ultrasound before and after the flap elevation is the most efficient method.

Abstract:
Introduction and Purpose: Surgical delay is a historically important procedure but getting less popular after the evolution of better techniques for musculocutaneous, fasciacutaneous and free flaps. Therefore the usage of this technique became limited for random and axial pattern flaps. Free flap failure rate ranges between 4-13% in qualified centers, despite the selection of the patients, innovations of microsurgery, preperation of recipient site and donor area. Lately anatomical studies define the flap designs and angiosomes but it couldnt prevent the flap failure as a reconstructive surgery problem. In this experimental study, ultrasound assisted flap delay technique compared with surgical delay procedure and topographical, histological, biochemical and microangiographic evaluation performed of flap survival.
Materials and Methods: This study included 4 months old 98 male Sprague Dawley rats range between 300-450 grams. They divided into 8 groups consisting of 11 animals in each group. Remaining 10 animals used for biochemical analysis of VEGF rate with the biopsies of 3th day for surgical delay technique performed rats. In this study 1st group as control, 2nd group as surgical delay, 3th group as postoperative ultrasound treatment, 4th group as postoperative ultrasound sham, 5th group as preoperative ultrasound treatment, 6th group as preoperative ultrasound sham, 7th group as pre and postoperative ultrasound treatment, 8th group as pre and postoperative ultrasound sham has been selected. McFalene flap model with the dimensions of 2x8 cm has been performed to the animals. Flap vitality rate has been evaluated after the 14th day of flap elevation. Tissue VEGF rate measured for all animals. Total vessel count and flap vitality rate determined. Additionally one animal choosed for each group for imaging of flap vascularity with microangioagraphy. Statistical analysis has been performed and compared with the obtained datas.
Results: Flap vitality rate in control group was %38.75±3.8, in surgical delay group was %76.6±3.3, in postoperative ultrasound treatment group was  %61.29, ±3.6, in postoperative ultrasound sham group was %42.05±5.8, in preoperative ultrasound treatment group was %68.6±2.9, in preoperative ultrasound sham group was %45.5±4.1, in pre and postoperative ultrasound treatment group was %79.7±2.7, in pre and postoperative ultrasound sham group was %47.5±5.5. Tissue VEGF rate in control group was 729.37 pg/ml/gr, in surgical delay group was 2214.06 pg/ml/gr, in postoperative ultrasound treatment group was 3164.64 pg/ml/gr, in postoperative ultrasound sham group was 1383.13 pg/ml/gr, in preoperative ultrasound treatment group was 2197.51  pg/ml/gr, in preoperative ultrasound sham group was 927.83 pg/ml/gr, in pre and postoperative ultrasound treatment group was 2827.21 pg/ml/gr, in pre and postoperative ultrasound sham group was 1111.58 pg/ml/gr.
Microangiographic visualization showed that flaps nourished in multiple places with more and larger vessels in surgical delay and pre and postoperative ultrasound treatment groups compared to other groups.  Increased vascularity rate in microangiographic evaluation in postoperative ultrasound treatment group and preoperative ultrasound treatment group compared to control group and other ultrasound sham groups detected in statistically significant fashion. Vascularity ranking for all groups obtained as; surgical delay ≥ pre and postoperative ultrasound treatment group > preoperative ultrasound treatment group ≥ postoperative ultrasound treatment group > pre and postoperative ultrasound sham group > preoperative ultrasound sham group ≥ postoperative ultrasound sham group > control group.
Vascular count in1 mm2  with the biopsies taken after the surgical procedure in control group was 24,2/mm2, in surgical delay group was 26,9/mm2, in postoperative ultrasound treatment group was  25,2/mm2, in postoperative ultrasound sham group was 24,5/mm2, in preoperative ultrasound treatment group was 26,1/mm2, in preoperative ultrasound sham group was 24,9/mm2, in pre and postoperative ultrasound treatment group was 27,2/mm2, in pre and postoperative ultrasound sham group was 25,1/mm2.
Conclusion: Ultrasound is an ideal method to increase flap vitality as performing before or after the flap elevation. Combining application of the ultrasound before and after the flap elevation is the most efficient method.