Estudo dos efeitos do extrato de sementes de <i>Euterpe oleracea</i> Mart. (Açaí) e do Cilostazol sobre a microcirculação cutânea e a viabilidade de retalhos miocutâneos transversos do músculo reto abdominal em hamsters saudáveis, sob influência da nicotina ou diabéticos

• Autor(a) principal: Mota, Denise Salles Coelho da
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/12679
• topic: Ischaemic Flaps; TRAM flaps; Microcirculation; Smoking; Nicotine; Diabetes mellitus; Açaí; Cilostazol; Retalhos isquêmicos; Retalhos TRAM; Microcirculação; Tabagismo; Nicotina; Diabetes mellitus; Açaí; Cilostazol; Isquemia; Reto do Abdome Irrigação sanguínea; Retalhos cirúrgicos; Microcirculação; Fumo Vício Efeito fisiológico; Nicotina Efeito fisiológico; Diabetes Complicações e sequelas; Açaí Uso terapêutico; Fosfodiesterase Inibidores Uso terapêutico; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CIRURGIA::CIRURGIA PLASTICA E RESTAURADORA

The main complication of surgery flaps transfer is tissue necrosis caused by inadequate blood perfusion. Ischemic complications of conventional transverse rectus abdominis myocutaneous (TRAM) flap mainly occur in patients with risk factors such as vascular disorders associated with smoking and diabetes mellitus. The objective of this study was to evaluate if the preoperative treatment, continued postoperatively, with hydroalcoholic açai seed (ESA), agent with antioxidant effects and endothelium-dependent vasodilator, or with cilostazol (CLZ), vasodilator and antiplatelet agent, would protect hamsters TRAM flaps against ischemic injury and against the harmful effects of nicotine and type 2 diabetes mellitus, improving microvascular blood perfusion and increasing their survival. One hundred and seventeen hamsters were divided into three experimental groups: (1) Healthy; (2) Nicotine and (3) High fat diet-induced diabetes, with three subgroups of oral treatment each: (a) Placebo; (B) ESA and (c) CLZ. Caudally single pedicle TRAM flaps were divided longitudinally into four vascular zones (I to IV), and evaluated for the presence of capillary blood flow (FOFS), perfused vascular density (PVD) and microvascular flow index (MFI), by orthogonal polarization spectral image technique, in three postoperative times: (1) immediately after flap suture (immedPO); (2) 24 hours postoperative (24hPO) and (3) 7th postoperative day (7thPOD), and for survival. In the Healthy group, in zone I, ESA increased PVD at immedPO and ESA and CLZ increased FOFS and PVD at 24hPO; in zone II, CLZ increased FOFS, PVD and MFI at immedPO and FOFS at 24hPO; in zone III, ESA and CLZ increased FOFS in the three times, and PVD and MFI at immedPO and 24hPO; in zone IV, CLZ increased FOFS at immedPO and at 7th POD, ESA increased FOFS at 7thPOD and both increased PVD and MFI in the three times. The treatments with ESA and CLZ, individually, increased the percentage of viable area in zones III and IV, with respect to the Placebo. In nicotine group, CLZ increased FOFS in Zone I, at immedPO; CLZ increased PVD and MFI in zone II, at immedPO and at 7thPOD and in zone III, at the immedPO and 24hPO, in relation to placebo. In Diabetes group, CLZ increased FOFS, PVD and MFI at immedPO in zone III; ESA decreased PVD and MFI, in zone II, at immed PO, and in zone III, at 24h PO and 7th POD, with respect to placebo. There was no increased survival in Nicotine and Diabetes groups. In conclusion, we have demonstrated the protective effect of preoperative treatment with ESA or CLZ against TRAM flaps ischemic injury in healthy hamsters, by improving microvascular blood perfusion and increasing survival of contralateral vascular pedicle regions (zones III and IV). There was no protective effect of treatments against the deleterious effects of nicotine and type 2 diabetes mellitus in hamsters TRAM flaps.