Ulus Travma Acil Cerrahi Derg. 2018; 24(5): 405-411 | DOI: 10.5505/tjtes.2018.59280

Kitosan kaplý ipliklerin anastomoz gücü arttýrma üzerine etkisi

Yuksel Altýnel¹, Soon Soup Chung², Guven Okay³, Nesrin Ugras⁴, Ahmet Fatih Isik⁵, Ersin Ozturk¹, Halil Ozguc^1
1Uludað Üniversitesi Tip Fakültesi, Genel Cerrahi Anabilim Dalý, Bursa
²Ewha Üniversitesi Hastanesi, Genel Cerrahi Anabilim Dalý, Seul-Kore
³Uludað Üniversitesi Tip Fakültesi, Biostatistics Anabilim Dalý, Bursa
⁴Uludað Üniversitesi Tip Fakültesi, Patoloji Anabilim Dalý, Bursa
⁵Uludað Üniversitesi Tekstil Mühendisliði Fakültesi, Tekstil Anabilim Dalý, Bursa

AMAÇ: Yara iyileþmesi etkisiyle, kitosan kaplý ipliklerin baðýrsak anastomozu gücü üzerine uygulanabilir olmasýný araþtýrdýk.
GEREÇ VE YÖNTEM: Vikril ve PDS iplikler %2 kitosanla kaplandý. Laparatomi birinci gruba uygulanýrken, kitosan ikici grupta periton boþluðuna uygulandý. Takibinde sýrasýyla vikril, PDS, kitosan kaplý vikril ve kitosan kaplý PDS iplikler kolon anastomozunda kullanýldý. Yedinci ve 14. günlerde her gruptan sekiz sýçan sakrifiye edilerek incelemesi yapýldý.
BULGULAR: Kitosan ve kontrol grubunun adezyon deðeri iplik gruplarýna göre anlamlý olarak daha düþük saptandý (p<0.05). Kitosan kaplý vikril grubunun 14. günde vaskülarizasyon deðeri, kitosan kaplý PDS iplik grubuna göre anlamlý olarak daha az olduðu belirlendi (p=0.038). Kitosan kaplý vikrilin 14. gücünde, anastomoz vaskülarizasyonu ve fibroblast hücreleri üzerinde vikril ve kitosan kaplý PDS göre etkisi daha düþük bulundu (p<0.05). Kitosan kaplý vikrilin 14. ve yedinci günündeki in vitro mukavemet gücü vikrilden daha yüksek olmasýna raðmen (p<0.05), in vivo farklýlýk görülmedi. The PDS-kitosan’ýn mukavemet gücü in vivo yedinci günde, PDS’den daha az olarak saptandý (p<0.05).
TARTIÞMA: Kitosan ile kaplama, anastomoz gücünü ve adezyon etkisini hafif oranda in vitro vikril ve in vivo PDS üzerinde arttýrdý.

Anahtar Kelimeler: Anastomoz, kitosan; mukavemet gücü, PDS ve Vicryl iplikler; yara iyileþmesi.

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Effect of chitosan coating on surgical sutures to strengthen the colonic anastomosis

Yuksel Altýnel¹, Soon Soup Chung², Guven Okay³, Nesrin Ugras⁴, Ahmet Fatih Isik⁵, Ersin Ozturk¹, Halil Ozguc^1
1Department of General Surgery, Uludað University Faculty of Medicine, Bursa-Turkey
²Department of General Surgery, Ewha University Medical Faculty, Seoul-Korea
³Department of Biostatistics, Uludað University Faculty of Medicine, Bursa-Turkey
⁴Department of Pathology, Uludað University Hospital, Bursa-Turkey
⁵Department of Textile, Uludað University Faculty of Textile Engineering, Bursa-Turkey

BACKGROUND: We evaluated the feasibility of chitosan-coated sutures for intestinal anastomosis strength through wound-healing effect.
METHODS: Vicryl and PDS sutures were coated with 2% chitosan. While laparotomy was applied to the first group, chitosan was applied in the peritoneal cavity in the second group. Then the following materials were applied to colon anastomosis, in order: Vicryl, PDS, chitosan-coated Vicryl, and chitosan-coated PDS sutures. On the 7th and 14th days, eight rats from each group were euthanized.
RESULTS: The adhesion scores of chitosan and control groups were lower than the suture groups. The vascularization of Vicryl–chitosan was lower than PDS–chitosan on the 14th day (p=0.038). Fibroblast cells and vascularization of anastomosis with chitosan-coated Vicryl were lower than Vicryl and chitosan-coated PDS on the 14th day (p<0.05). The tensile strength of Vicryl–chitosan increased more than Vicryl in vitro (p<0.05) on the 14th and 7th days, but there was no difference in vivo. The tensile strength of PDS–chitosan decreased more than PDS on the 7th day in vivo (p<0.05).
CONCLUSION: The chitosan-coating effect on the adhesion and reinforcement of anastomosis in some parts of Vicryl in vitro and PDS in vivo was slightly improved.

Keywords: Anastomosis, chitosan; PDS suture; tensile strength; Vicryl suture; wound healing.

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