Pediküllü Transvers Rektus Abdominis Kas Deri Flebi Üzerinde Radial Ekstrakorporeal Şok Dalga Terapisinin Flep Yaşamsallığına Etkisi: Deneysel Çalışma

Abstract

In our study, we hypothesize that the radial extracorporeal shock wave therapy (rESWT) may decrease the necrosis that occurs in zone 4 of pedicled transverse rectus abdominis myocutaneous flap. An experimental study is conducted to test this hypothesis. In the study, 24 Wistar Albino rats were used; TRAM flap, 5x2.5 cm in size, with a right caudal epigastric artery pedicle was designed as the flap model. Three groups, with 8 rats in each, were designed. Group 1 was the control group; after being raised, the TRAM flap was sutured back to its bed without any further intervention. In Group 2, the TRAM flap was raised, and rESWT was administered immediately after the flap was sutured back to its bed. In Group 3, rESWT was applied 7 days prior to the raising of the flap. Seven days after the administration of rESWT, TRAM flap was raised and then sutured back to its bed. In order to prevent revascularization from the bed of the flap, a silicon sheath was placed onto the flap ground after the flap was raised in all groups. All groups underwent topographic examination by being photographed for vital area measurements 5 days after the surgery. Zones 1 and 4 of the flaps of 21 rats were histopathologically evaluated to examine the capillary and inflammatory cell density. Microangiography was performed on 3 rats, one from each group, to demonstrate the vascularization. In topographic examination, the percentage of vital surface was 61.82% in Group 1, 77.65% in Group 2, and 79.89% in Group 3. In Groups 2 and 3, the average of vital surface was higher compared to Group 1, and this difference was statistically significant (Group 1 - Group 2 p=0.016, Group 1 - Group 3 p=0.003). The difference among Groups 2 and 3 was not statistically significant. Histopathologically, capillary density in zone 4 of Groups 2 and 3 was higher compared to Group 1, and this difference was statistically significant (p<0.05). The difference among Groups 2 and 3 was not statistically significant. Intensity of inflammatory cells in zone 4 of Group 1 was significantly higher compared to Group 2 and Group 3 (p<0.05). Although less inflammatory cells were detected in Group 3 compared to Group 2, the difference between these groups was not evaluated as statistically significant. No statistically significant differences in capillary density and inflammatory cell intensity were detected between the zones 1 of different groups. On microangiography images, higher vascularization in Group 2 and Group 3 compared to Group 1 was observed. These results demonstrate that the radial extracorporeal shock wave therapy could be used as a new, practical and clinically applicable method to enhance the viability of the TRAM flap.