Bioparçalanabilir jelatin maddesi ile 5 florourasil yavaş salınımının fleksör tendon onarımı üzerindeki etkileri: Tavuk modelinde deneysel çalışma

Abstract

(n=6); 10 mg 5 Florourasil içeren jel grubu. Grup 5 (n=6); 20 mg 5 Florourasil içeren jel grubu. Grup 6 (n=6); 30 mg 5 Florourasil içeren jel grubu. Örnekler patolog tarafından sinovyal yapışıklık skorlama yöntemi ile değerlendirildi ve Grup 4, diğer gruplarla istatistiksel farklılık gösterdi. Grup 2 ile karşılaştırıldığında adezyon skorlarında azalma saptandı ( p=0.009, p<0.05 ). Elektron mikroskopide incelenen kesitlerde Grup 4 te fibroblast hücreleri aktif idi, kollajen sentezi ve fibril düzeni uniformdu. Grup 2'de ise kollajen fibrilleri düzensiz idi. Biomekanik angüler rotasyon testinde tüm gruplar değerlendirildiğinde Grup 4, Grup 2 ile farklılık gösterirken ( p=0.002, p<0.05 ), Grup 4 açısal değerleri ( 14:76.3°, SS:3.01°) cerrahi geçirmeyen grup ile yakınlık gösterdi (14 80.8 °, SS:2.3° ). Bu çalışmada, 10 mg 5 Florourasil ile jelatin maddesi kullanarak, 5 Florourasilin düşük dozda yavaş salınımını sağlayarak, fleksör tendon iyileşmesi üzerinde olumlu etkilerinin olduğunu, ve bu uygulama ile tendon adezyonlarının daha etkin bir şekilde önlenebileceğini saptadık. Anahtar kelimeler : 5 Florourasil, Jelatin, Yavaş salınım, Fleksör tendon, Adezyon

The Effects of 5 Fluorouracil on Flexor Tendon Healing by Using a Biodegradable Gelatin Slow Releasing System: Experimental Study in a Chicken Model. Hacettepe University Faculty of Medicine, Thesis in Plastic and Reconstructive Surgery, Ankara 2003 Adhesion formation after flexor tendon injury is an challenging problem for hand surgeons. Recent studies focus on various methods in preventing such adhesions.Topical application of 5 Fluorouracil shows promising results in preventing tendon adhesions. In this study, we planned to apply 5 Fluorouracil via a slow releasing gelatin system and investigated it's effects on flexor tendon healing. Gelatins were prepared in 10X20X1 mm size and loaded with 10, 20 and 30 mg 5 Florourasil. 30 adult white Leghorn chickens weighing between 2 and 2.5 Kg were used. The flexor digitorum profundus tendon to the third and fourth toe were severed and primarily repaired using modified Kessler technique. Study groups were: Group 1 (n=6); randomly selected from 30 animals,six non-operated left lower extremities. Group 2 (n=6); operative control. Group 3 (n=6); repaired tendons with the application of 5 Fluorouracil free gelatin films. Group 4(n=6); gelatin films loaded with 10 mg 5 Fluorouracil. Group 5(n=6); gelatin films loaded with 20 mg 5 Fluorouracil. Group 6(n=6); gelatin films loaded with 30 mg 5 Fluorouracil. The repaired extremities were casted and immobilized for 3 weeks. After sacrificing study groups, tendons were examined with light microscopy and electron microscopy to evaluate the adhesion formation histologically, and with biomechanical anguler rotation test to asses tendon gliding. Results revealed that group 4 showedvıı apparent decrease in adhesion formation when compared with operative control group (p=0.009, p <0`05). Histologic analysis also showed that use of gelatin film enabled an uniform application of 5 Fluorouracil which led to a uniform decrease in adhesion in the synovial space. In electron microscope examination, group 4 showed active fibroblast cells and collagen synthesis. Collagen fibrils were uniformly oriented. In group 2 the collagen fibrils were disorganized. Group 6 showed high activity and inflammation. In biomechanical anguler rotation test, results of group 4 in comparing to group 2 were statistically different (p=0.002, p <0.05). The mean angular values of group 4 (76.3°, SD:3.0l) were approaching mean anguler values of non-operative control group(80.8°, SD: 2.3)(group 6). This study showed that low dose application of 5 Fluorouracil via the slow releasing gelatin system have a promising effect on flexor tendon healing in regarding adhesion formation and functional results after injury. Key words: 5 Fluorouracil, Gelatin, Flexor tendon, Slow releasing, Adhesions