Publication: Posttravmatik stres bozukluğunun flep yaşayabilirliğine etkisi
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Bezmialem Vakıf University
In reconstructive surgery, trauma patients constitute a significant amount of patients with tissue defects that we repair with flaps. While psychiatric consultation was requested for those with psychiatric symptoms and antidepressant treatment was initiated, and psychiatric treatment was not given to patients without symptoms. There is no research in the literatüre investigating the effects of posttraumatic stress disorder (PTSD) and antidepressant drug use on flap survival. The aim of this study was to investigate the effect of PTSD and antidepressant drug use on flap survival in trauma patients. 42 male Sprague Dawley rats weighing 300-350 g were used in the study. Rats were divided into 6 groups of 7 rats each. Single Prolonged Stress (SPS) model was applied to the groups to be formed PTSD in rats. After 1 week, antidepressant medications were administered to the groups. Group 1 (sham) did not receive SPS and did not receive antidepressants. SPS was applied in Group 2 (control) but no antidepressant was given. In Group 3, SPS and paroxetine was administered. In Group 4, SPS was administered and Duloxetine was given. In Group 5, SPS was administered and Amitriptyline was given. In Group 6, SPS was administered and Rasagiline was given. Two weeks after the initiation of the drugs, the cranial-based 3x9 cm random patterned skin flaps were lifted over the deep fascia from the back of the rats and were sutured. Then antidepressant treatment continued for a week further. Photographic, biochemical and histological analyses were performed after 28 days. "SketchAndCalc Area Calculator" (iCalc inc. U.S.A.) was used for photographic analysis. For histological analysis, tissue samples were taken from flaps predetermined areas from all rats and after appropriate procedures and staining, samples were examined under Nikon (Eclipse 920248, USA) light microscope and the images were transferred to computer via a software fully compatible with Nikon (MDS-Fi2-U3 (USA)) camera. Epithelial thickness of all groups was measured from 5 different areas at 200 magnification (X20). After taking histological samples for biochemical analysis, tissue samples were taken from the most distal region of the flap and the amount of HIF1a, Cyclophylline A, MMP2, MMP9, VEGF, EGF, IL1b, IL6 and TNFα were measured spectrophotometrically by ELISA kits. In the photographic analysis of our study, a significant difference was found between the control group compared to sham and experimental groups (p <0.05). There was no significant difference between sham group and antidepressant groups (p> 0.05). In addition, there was no significant difference between the experimental groups (p> 0.05). In our study, the group with the highest epidermis thickness was determined as Group 3. Epidermis thickness of Group 3 was higher than sham group. Although there was a significant difference between the sham group and the control group (p <0.05), no significant difference was found between the control group and the experimental groups (p> 0.05). Although there was no significant difference between Sham group compared to Group 3, Group 4 and Group 5, there was a significant difference between Sham group and Group 6. Tissue HIF1α, CycA, MMP2, MMP9, VEGF, EGF, IL1β, IL6 and TNFα were found to be significantly higher than the sham group (p <0.05). There was a significant difference between Group 3 and control group in MMP2, VEGF, EGF, IL1β and TNFα levels. As a result, untreated PTSD reduces flap viability. The drugs used were not statistically superior to each other.
Thesis (Medical)--Bezmialem Vakıf University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, 2019
Plastik ve Rekonstrüktif Cerrahi = Plastic and Reconstructive Surgery