Sıçanlarda göğüs ön duvarına verilen radyoterapinin stromal vasküler fraksiyon enjekte edilen latissimus dorsi kası üzerine etkisi
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Tarih
2023
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç:Toraks bölgesinin rekonstrüksiyonunda latissimus dorsi kas flebi uzun zamandır
kullanılmaktadır. Yara yatağının enfektif olması, onkolojik süreçlerden sonra bu bölgeye
verilen radyoterapi bu kas flebini kullanırken karşılaşılabilecek zorluklardan birkaçını
oluşturmaktadır. Özellikle radyoterapinin olumsuz lokal yan etkilerini gidermek ve yara
iyileşmesine yardımcı olmak adına birçok tedavi stratejisi sunulmasına rağmen; kesin bir
tedavi modalitesi bulunmamaktadır. Mezenkimal kök hücreler trofik faktörler salgılayarak yara iyileşmesini ve doku rejenerasyonunu indükleyen bağ dokunun temel yapıtaşlarından
biridir. Çalışmamızda mezenkimal kök hücreden zengin stromal vasküler fraksiyon latissimus dorsi kasına enjekte edilerek; radyoterapinin latissimus dorsi kas flebi üzerinde
oluşturabileceği yan etkilerdeki değişikliği histopatolojik ve elektrofizyolojik olarak
araştırmayı hedefledik. Materyal ve Metod:Bu çalışma, her grupta 10 (n=10) sıçan olmak üzere 3 grup oluşturularak
30 adet sıçan üzerinde gerçekleştirildi. Sıçanların omentum yağ dokusu alınarak Histoloji Anabilim Dalı tarafından mezenkimal kök hücreden zengin stromal vasküler fraksiyon
hücresel pelleti elde edildi. Bu hücresel pellet cerrahi ekip tarafından göğüs ön duvarına
getirilen latissimus dorsi kasına homojen olarak intramusküler enjekte edildi. Grup I: Göğüs
ön duvarındaki cilt altı poşa nörovasküler bağlantısı korunan latissimus dorsi kası transpoze
edildi; Grup II: Göğüs ön duvarındaki cilt altı poşa nörovasküler bağlantısı korunarak
iv
transpoze getirilen latissimus dorsi kasına stromal vasküler fraksiyon enjekte edildi. Bu işlemden 10 gün sonra tek fraksiyonda 20 Gy’lik eksternal radyoterapi uygulandı. Cerrahi işlemleri takip eden 3. ayda her üç grubun transpoze edilen latissimus dorsi kaslarının EMG testi ile ampitüd ve latans parametreleri hesaplandı. Sıçanlar sakrifiye edildikten sonra göğüs ön duvarına getirilen latissimus dorsi kasından alınan örnekler histopatolojik incelemelerle değerlendirildi.
Bulgular: Çalışmaya alınan ratlara uygulanan işlemler sonrası EMG’de latans ve amplitüd parametreleri değerlendirildi. Grup I ratlara ait latans ortanca değeri 1,09 (0,96-1,35), Grup II 1,05 (0,91-1,45), Grup III 1,08 (0,81-1,59) olarak belirlendi. Grup I ratlara ait amplitüd ortanca değeri 7,14 (2,49-11,55), Grup II 3,65 (2,12-16,20), Grup III 7,10 (2,60-22,96) olarak belirlendi EMG sonuçlarının Grup I ve Grup II arasında dağılımı istatistiksel olarak benzer tespit edildi (p>0,05). EMG parametrelerinin Grup II ve Grup III arasında dağılımında istatistiksel olarak anlamlı düzeyde fark belirlenmedi (p>0,05). Histopatolojik parametrelerin grup içindeki ortalamaları ele alınarak gerçekleştirilen karşılaştırmalarda atrofi ve fibrozis derecesi Grup I’de Grup II’ye göre istatistiksel olarak anlamlı düzeyde düşük belirlendi (p değerleri sırasıyla; p=0,019; p=0,015). Grup I ve Grup II arasında vaskülarizasyon, yağlı değişiklik, inflamasyon verilerinin dağılımında istatistiksel olarak anlamlı düzeyde fark belirlenmedi (p>0,05). Grup III’te Grup II’ye göre atrofi ve fibrozis derecesi istatistiksel olarak anlamlı düzeyde düşük belirlendi (p değerleri sırasıyla; p=0,007; p=0,029). Grup II ve Grup III arasında vaskülarizasyon, yağlı değişiklik, inflamasyon verilerinin dağılımında istatistiksel olarak anlamlı düzeyde fark belirlenmedi (p>0,05).
Sonuç: Bu çalışmada deneysel model üzerinde stromal vasküler fraksiyon enjekte edilen latissimus dorsi kasının radyoterapinin oluşturduğu atrofi ve fibrozis histopatolojik parametreleri açısından etkinliğinin arttığını gösterdik. Göğüs ön duvarı yumuşak doku rekonstrüksiyonunda stromal vasküler fraksiyon klinik uygulanmasının radyoterapinin
oluşturabileceği yan etkilerin azaltılması üzerine olumlu katkıları ileri araştırmalarla desteklenebilir.
Objective: The use of the latissimus dorsi muscle flap in the reconstruction of thoracic region had been mentioned since the ancient times. The infectivity of the wound bed and the effects of radiotherapy given to this region after oncological processes are some of the difficulties that may be encountered while using this muscle flap. Although many treatment strategies have been described to enhance wound healing by eliminate the negative local effects of radiotherapy, there is no consensus regarding the definite treatment modality. Mesenchymal stem cells are one of the basic building blocks of the connective tissue and responsible of releasing several trophic factors which induce wound healing and tissue regeneration. In this study, we aimed to investigate the resistance of mesenchymal stem cell- enriched latissimus dorsi muscle flap against the adverse side effects of radiation in terms of histopathological and electrophysiological evaluations. Materials and Methods: This study was carried out on 30 rats by forming 3 groups with 10 (n=10) rats in each group. After the omental adipose tissue of the rats was taken, cellular pellets of mesenchymal stem cell- enriched stromal vascular fraction was obtained by the Department of Histology. This cellular pellet was homogeneously injected into the latissimus dorsi muscle, which was brought to the anterior chest wall by the surgical team. Group I: The latissimus dorsi muscle was transposed to the subcutaneous pocket on the anterior chest wall, with the preservation of the neurovascular connections. Group II: after transposing the latissimus dorsi muscle to the subcutaneous pocket on the anterior chest wall, 20 Gy external radiotherapy was vii applied in a single fraction 10 days after the transposition. Group III: after transposing the latissimus dorsi muscle to the subcutaneous pocket on the anterior chest wall, Stromal vascular fraction was injected into the transposed muscle. 10 days after this procedure, external radiotherapy of 20 Gy was applied in a single fraction. At the postoperative 3rd month, amplitude and latency values of all the muscles in the 3 groups were obtained by EMG test. After the rats were sacrificed, samples taken from the latissimus dorsi muscle were evaluated by histopathological examinations. The median latency values were: 1.09 (0.96-1.35), 1.05 (0.91-1.45) and1.08 (0.81-1.59) for Group I, II and III, respectively. However, the median amplitude values were: 7.14 (2.49-11.55), 3.65 (2.12-16.20) and 7.10 (2.60-22.96) for Group I, II and III, respectively. The distribution of EMG results between Group I and Group II was found to be statistically similar (p>0.05). There was no statistically significant difference in the distribution of EMG parameters between Group II and Group III (p>0.05) Results: The degree of atrophy and fibrosis were found to be statistically significantly lower in Group I compared to Group II in the comparisons made by considering the averages of histopathological parameters within the groups (p=0.019; p=0.015, respectively). There was no statistically significant difference between Group I and Group II in terms of vascularization, fatty change and inflammation (p>0.05). The degree of atrophy and fibrosis were found to be statistically significantly lower in Group III compared to Group II (p=0.007; p=0.029, respectively). There was no statistically significant difference between Group II and Group III in terms of vascularization, fatty change and inflammation (p>0.05). Conclusions: It was revealed by histopathological evaluation that stromal vascular fraction-enriched latissimus dorsi muscle gained resistance against radiotherapy-induced atrophy and fibrosis in this experimental study. The positive effects of clinical application of stromal vascular fraction in soft tissue reconstruction of the anterior chest wall on reducing the side effects of radiotherapy can be supported by further research.
Objective: The use of the latissimus dorsi muscle flap in the reconstruction of thoracic region had been mentioned since the ancient times. The infectivity of the wound bed and the effects of radiotherapy given to this region after oncological processes are some of the difficulties that may be encountered while using this muscle flap. Although many treatment strategies have been described to enhance wound healing by eliminate the negative local effects of radiotherapy, there is no consensus regarding the definite treatment modality. Mesenchymal stem cells are one of the basic building blocks of the connective tissue and responsible of releasing several trophic factors which induce wound healing and tissue regeneration. In this study, we aimed to investigate the resistance of mesenchymal stem cell- enriched latissimus dorsi muscle flap against the adverse side effects of radiation in terms of histopathological and electrophysiological evaluations. Materials and Methods: This study was carried out on 30 rats by forming 3 groups with 10 (n=10) rats in each group. After the omental adipose tissue of the rats was taken, cellular pellets of mesenchymal stem cell- enriched stromal vascular fraction was obtained by the Department of Histology. This cellular pellet was homogeneously injected into the latissimus dorsi muscle, which was brought to the anterior chest wall by the surgical team. Group I: The latissimus dorsi muscle was transposed to the subcutaneous pocket on the anterior chest wall, with the preservation of the neurovascular connections. Group II: after transposing the latissimus dorsi muscle to the subcutaneous pocket on the anterior chest wall, 20 Gy external radiotherapy was vii applied in a single fraction 10 days after the transposition. Group III: after transposing the latissimus dorsi muscle to the subcutaneous pocket on the anterior chest wall, Stromal vascular fraction was injected into the transposed muscle. 10 days after this procedure, external radiotherapy of 20 Gy was applied in a single fraction. At the postoperative 3rd month, amplitude and latency values of all the muscles in the 3 groups were obtained by EMG test. After the rats were sacrificed, samples taken from the latissimus dorsi muscle were evaluated by histopathological examinations. The median latency values were: 1.09 (0.96-1.35), 1.05 (0.91-1.45) and1.08 (0.81-1.59) for Group I, II and III, respectively. However, the median amplitude values were: 7.14 (2.49-11.55), 3.65 (2.12-16.20) and 7.10 (2.60-22.96) for Group I, II and III, respectively. The distribution of EMG results between Group I and Group II was found to be statistically similar (p>0.05). There was no statistically significant difference in the distribution of EMG parameters between Group II and Group III (p>0.05) Results: The degree of atrophy and fibrosis were found to be statistically significantly lower in Group I compared to Group II in the comparisons made by considering the averages of histopathological parameters within the groups (p=0.019; p=0.015, respectively). There was no statistically significant difference between Group I and Group II in terms of vascularization, fatty change and inflammation (p>0.05). The degree of atrophy and fibrosis were found to be statistically significantly lower in Group III compared to Group II (p=0.007; p=0.029, respectively). There was no statistically significant difference between Group II and Group III in terms of vascularization, fatty change and inflammation (p>0.05). Conclusions: It was revealed by histopathological evaluation that stromal vascular fraction-enriched latissimus dorsi muscle gained resistance against radiotherapy-induced atrophy and fibrosis in this experimental study. The positive effects of clinical application of stromal vascular fraction in soft tissue reconstruction of the anterior chest wall on reducing the side effects of radiotherapy can be supported by further research.
Açıklama
Anahtar Kelimeler
Latissimus dorsi kas flebi, Stromal vasküler fraksiyon, Toraks rekonstrüksiyonu, Latissimus dorsi muscle flap, Reconstruction of thoracic region, Stromal vascular fraction
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Soylu, A. (2023). Sıçanlarda göğüs ön duvarına verilen radyoterapinin stromal vasküler fraksiyon enjekte edilen latissimus dorsi kası üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Plastik Cerrahi Anabilim Dalı, Konya.
