Deneysel sıçan modelinde iskemiye bağlı deri flep nekrozunda hemostatik ajan kullanım

Year 2019, Volume: 10 Issue: 3, 388 - 395, 30.09.2019

Aylin Akbulut , Koray Gursoy , Nihat Yumusak , Gokhan Koca , Meliha Korkmaz

https://doi.org/10.18663/tjcl.589447

Abstract

Amaç:
Operasyon
alanlarında hemostazı elde etmek için bitki bazlı hemostatik
ajanların kullanımı artmaktadır. Ancak bu ajanların vasküler
kanlanmanın önemli olduğu durumlarda kullanımı ile ilgili
herhangi çalışma bulunmamaktadır.
Kullanımı
son yıllarda yaygınlaşan, bitki bazlı bir topikal hemostatik ajan
olan Ankaferd’in (ABS) McFarlane flep viyabilitesi
üzerindeki etkisini sıçan
modelinde
inceledik.

Gereç
ve Yöntemler:
Yirmi sıçanda
McFarlane
tarzı flepler genel anestezi altında eleve edildi. Sıçanların
10’u Grup I olarak atandı ve başka ek tedavi uygulanmadı. Grup
II'deki 10 sıçanın fleplerinin alt yüzlerine ABS uygulandı.
Flepler orijinal yerlerine adapte edildikten sonraki 7. günde flap
viabilitesi için sintigrafik çekim ve dijital olarak çekilen
fotoğraflarla topografik analiz yapıldı. Canlı flep alanları
sintigrafik görüntülerde belirlendi ve bu alanların pikselleri
total flep alanına oranlandı. Sonrasında flep dokuları
histopatolojik olarak değerlendirildi.

Bulgular:
Sintigrafik
analizde, Grup I ile karşılaştırıldığında, Grup II’de
flepin proksimal sap kesiminde sınırlı alanda viyabilite gözlendi
ve flep viyabilitesi yüzdesi Grup I ve Grup II için sırasıyla,
%56.33±9.94,
%26.27±7.05
olarak bulundu. Grup II’de gözlenen nekrotik doku yüzdesi Grup
I’e oranla anlamlı olarak yüksekti (p <0.001). Aynı şekilde
makroskopik gözlemle uyumlu olarak ABS ile tedavi edilen sıçanlar
kontrol grubu ile karşılaştırıldığında, topografik analizinde
bulunan canlı
doku alanı anlamlı olarak daha küçüktü
(%26.81±5.55,
karşın %59.66±12.04,
p<0.001).
Benzer şekilde histopatolojik sonuçlarda, ABS grubunda kontrol
grubuyla karşılaştırıldığında histopatolojik değişikliklerde
anlamlı artış (p <0.001), neovaskülarizasyonda anlamlı azalma
saptandı (p <0.001).

Sonuç:
Çalışmamızın sonucunda cerrahi hemostazdaki etkinliğine rağmen,
ABS kullanımının özellikle cilt flepleri gibi marjinal olarak
perfüze dokularda flep viyabilitesine olumsuz etkisi bulunmuştur.
Dolayısıyla, vasküler damarlanmanın önemli olduğu dokularda ABS
kullanımında dikkatli olunmalıdır

Keywords

Flep Canlılığı; Ankaferd; ABS (Ankaferd Blood Stopper); Hemostatik Ajan

Results of a hemostatic agent to potentiate ischemia-induced skin flap necrosis in an experimental rat model

Abstract

Aim:
The
uses of plant based hemostatic agents are increasing
for obtaining operative field hemostasis. However, their effects on
vascularly challenged tissue is not known. The aim of this study was
to investigate the effect, if any, of plant-based hemostatic agent,
Ankaferd (ABS) on flap viability in a rat model.

Material
and Methods: Twenty
rats underwent McFarlane flaps under
general anesthesia.
Ten rats in Group I received no other treatment. Ten rats in Group II
received ABS to the underside of flaps. Viable
flap area was determined in scintigraphic images and percentage of
viable flap area pixel size to the total flap area pixel size was
calculated.
Additionally all flap areas were digitally photographed and underwent
histopathologic evaluation.

Results:
Scintigraphic
analysis has shown limited viability at proximal pedicle zone of flap
in Group II compared to Group I. The mean area of flap survival
percentage was calculated in
Group I and in Group II was as
follows respectively 56.33
±9.94%,
26.27±7.05%.
Differences between groups were statistically significant (p<0.001).
Similarly, Group II has shown significantly
smaller area of viable tissue percentage compared to Group I
(26.81±5.55%,
versus 59.66±12.04%,
p<0.001)
by digital photographic analysis. Histopathologic results were
significantly high in Group II compared to Group I (p<0.001)
whereas neovascularization was significantly low in Group II
compared to Group I (p<0.001).

Conclusion:
Despite
its efficacy in surgical hemostasis,
ABS use is
associated with an increased incidence of distal tip necrosis in
dorsal rat skin flaps. Therefore ABS use in marginally perfused
tissues particularly in random skin flaps should be cautious.

Keywords

Flap Viability; Ankaferd; ABS (Ankaferd Blood Stopper); Hemostatic Agent

References

• 1. Haznedaroglu BZ, Beyazit Y, Walker SL, Haznedaroglu IC. Pleiotropic cellular, hemostatic, and biological actions of Ankaferd hemostat. Crit Rev Oncol Hematol 2012; 83: 21–34.
• 2. Ozel-Demiralp D, İğci N, Ayhan B, Eğin Y, Haznedaroglu IC, Akar N. Prohemostatic and antithrombin activities of Ankaferd hemostat are linked to fibrinogen gamma chain and prothrombin by functional proteomic analyses. Clin Appl Thromb 2012; 18: 604–10.
• 3. Teker AM, Korkut AY, Gedikli O, Kahya V. Prospective, controlled clinical trial of Ankaferd Blood Stopper in children undergoing tonsillectomy. Int J Pediatr Otorhinolaryngol 2009; 73: 1742–45.
• 4. Aydın BK, Altan E, Acar MA, Erkoçak ÖF, Ugraş S. Effect of Ankaferd blood stopper® on tendon healing: an experimental study in a rat model of Achilles tendon injury. Eklem Hast Ve Cerrahisi Jt Dis Relat Surg 2015; 26: 31–37.
• 5. Findikçioğlu K, Findikçioğlu F. Ankaferd® Kanama Durdurucunun Plastik Cerrahi Pratiğinde Kullanım Alanları: Olgu Sunumlar. Türk Plast Rekonstrüktif Ve Estet Cerrahi Derg Turk J Plast Surg 2010 Jun 25; 17: 149–52.
• 6. Kuru S, Kismet K, Bag YM et al. Does the application of Ankaferd Blood Stopper rectally have positive effects on the healing of colorectal anastomosis and prevention of anastomotic leakage? An experimental study. Biomed Pharmacother 2017; 96: 968–73.
• 7. Akalin C, Kuru S, Barlas AM et al. Beneficial effects of Ankaferd Blood Stopper on dermal wound healing: an experimental study. Int Wound J 2014; 11: 64–68.
• 8. Dölen UC, Sungur N, Koca G et al. The Vasodilator Effect of a Cream Containing 10% Menthol and 15% Methyl Salicylate on Random-Pattern Skin Flaps in Rats. Arch Plast Surg 2015; 42: 695–703.
• 9. 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: 1024–34.
• 10. Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC. Evaluation of hemostatic effects of Ankaferd as an alternative medicine. Altern Med Rev. 2010; 15: 329–36.
• 11. Lee S-J, Umano K, Shibamoto T, Lee K-G. Identification of volatile components in basil (Ocimum basilicum L.) and thyme leaves (Thymus vulgaris L.) and their antioxidant properties. Food Chem 2005; 91: 131–37.
• 12. Sheela ML, Ramakrishna MK, Salimath BP. Angiogenic and proliferative effects of the cytokine VEGF in Ehrlich ascites tumor cells is inhibited by Glycyrrhiza glabra. Int Immunopharmacol 2006; 6: 494–98.
• 13. Yamakoshi J, Kataoka S, Koga T, Ariga T. Proanthocyanidin-rich extract from grape seeds attenuates the development of aortic atherosclerosis in cholesterol-fed rabbits. Atherosclerosis 1999; 142: 139–49.
• 14. Matsuda H, Ando S, Kato T, Morikawa T, Yoshikawa M. Inhibitors from the rhizomes of Alpinia officinarum on production of nitric oxide in lipopolysaccharide-activated macrophages and the structural requirements of diarylheptanoids for the activity. Bioorg Med Chem 2006; 14: 138–42.
• 15. Testai L, Chericoni S, Calderone V et al. Cardiovascular effects of Urtica dioica L.(Urticaceae) roots extracts: in vitro and in vivo pharmacological studies. J Ethnopharmacol. 2002;81:105–109.
• 16. Uğur A, Saraç N, Çankal DA, Özle M. The antioxidant and antimutagenic activities of Ankaferd blood stopper,a natural hemostatic agent used in dentistry. Turk J Med Sci 2016; 46: 657–63.
• 17. Koçak E, Akbal E, Taş A et al. Anti-inflammatory efficiency of Ankaferd blood stopper in experimental distal colitis model. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc 2013; 19: 126.
• 18. Kandemir O, Buyukates M, Kandemir NO et al. Demonstration of the histopathological and immunohistochemical effects of a novel hemostatic agent, ankaferd blood stopper, on vascular tissue in a rat aortic bleeding model. J Cardiothorac Surg 2010; 5: 1–7.
• 19. McFarlane RM, DeYoung G, Henry RA, McFarlane RM. The design of a pedicle flap in the rat to study necrosis and its prevention. Plast Reconstr Surg 1965; 35: 177–82.
• 20. Myers MB, Cherry G. Augmentation of survival in pedicle skin flaps by the chemical production of ischemia. Plast Reconstr Surg 1972; 49: 669.
• 21. Vedder N B. Flap Physiology. Philadelphia, PA: Saunders Elsevier; 2006. p. 483–506.
• 22. Stein HJ, Fayman MS, Oosthuizen MMJ, Hinder RA. Verapamil improves survival of rat hyperemic island skin flaps. Surgery 1989; 106: 617–23.
• 23. Goker H, Haznedaroglu IC, Ercetin S et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008; 36: 163–70.
• 24. Ariëns RAS. A new red cell shape helps the clot. Blood 2014; 123: 1442–43.
• 25. Kocyigit A, Guler EM, Haznedaroglu IC, Malkan UY. Ankaferd hemostat induces DNA damage, apoptosis and cytotoxic activity by generating reactive oxygen species in melanoma and normal cell lines. Int J Clin Exp Med 2017; 10: 2116–26.