Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Silikon İmplant Konmuş Sıçanlarda Aselüler Dermal Matriks Kullanımının Kapsül Kontraksiyonu Üzerine Etkisi
Effects of Acellular Dermal Matrix on Capsular Contracture Following Silicon Implant Placement in Rats
Mehmet Can ŞAKIa, Serhat ÖZBEKb, Şaduman BALABAN ADIMc, Gökhan OCAKOĞLUd
aVanity Estetik Cerrahi Merkezi, İstanbul, TÜRKİYE
bUludağ Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi ABD, Bursa, TÜRKİYE
cUludağ Üniversitesi Tıp Fakültesi, Patoloji ABD, Bursa, TÜRKİYE
dUludağ Üniversitesi Tıp Fakültesi, Biyoistatistik ABD, Bursa, TÜRKİYE
Turkiye Klinikleri J Med Sci.2020;40(4):418-24
doi: 10.5336/medsci.2020-75484
Article Language: TR
Full Text
ÖZET
 Amaç: Silikon meme implantlarının kullanılmaya başlandığı son 50 yılda, meme büyütme ve mastektomi sonrası meme rekonstrüksiyonu ameliyatlarının sayısında dramatik bir artış olmuştur. İmplant etrafında gözlenen kapsül kontraksiyonu, bu hasta gruplarında ikincil ameliyatı gerektiren en sık implant ilişkili komplikasyondur. İmplant ilişkili komplikasyonları azaltmak ve implant etrafında destek dokusu oluşturmak amacıyla aselüler dermal matriks (ADM) içeren ürünler kullanılmaktadır. Bu çalışmada, ADM'nin kapsül dokusu oluşumu üzerindeki etkileri, yara iyileşme sürecinde görülen benzer hücresel dinamikler göz önünde bulundurularak, incelenmeye çalışılmıştır. Gereç ve Yöntemler: Bu çalışmada 24 tane Sprague-Dawley tipi sıçan kullanılmıştır. Deneysel çalışmamızda sıçan pektoral kası kesilerek, silikon implantların yerleşeceği subpektoral cepler oluşturuldu. On iki deneğe sadece silikon implant subpektoral yerleştirilerek kontrol grubu; diğer 12 deneğe ise Belladerm® ile sarılmış silikon implant subpektoral yerleştirilerek deney grubu oluşturuldu. Altı haftalık takipten sonra tüm denekler sakrifiye edilerek, her implant etrafında oluşan kapsül dokusu histolojik incelemeye alındı. Bulgular: Histopatolojik değerlendirmede gruplar arasında, polimorfonükleer lökosit hücre (PMNL) yoğunluğu, mononükleer lökosit hücre yoğunluğu, sinovyal metaplazi kalınlığı istatistiksel olarak değerlendirilmiştir. Kontrol grubu ve deney grubu karşılaştırıldığında, PMNL yoğunluğu açısından 2 grup arasında anlamlı fark bulunamamıştır (p=0,93). Her 2 grup arasında monosit yoğunluğu karşılaştırıldığında deney grubunda, kontrol grubuna göre daha fazla monosit infiltrasyonu gözlenmiştir (p=0,26). Her 2 grup arasında inflamasyon yoğunluğu açısından karşılaştırma yapıldığında, deney grubunda daha fazla inflamasyon yoğunluğu saptanmıştır (p<0,001). Sinovyal metaplazi kalınlığı değer- lendirildiğinde her 2 grup arasında anlamlı fark saptanmıştır (p<0,001). Sonuç: Kapsül dokusu oluşumunda bimodal inflamatuar, yanıtın önemli bir süreçtir. Çalışmamızda, Belladerm® in rezorbsiyona uğramadığı ve bimodal inflamatuar yanıta göre dokuyla entegrasyona girdiği deneysel olarak kanıtlanmış oldu. Bu veri, ADM'nin kapsül oluşumu üzerine pozitif etkisi olarak yorumlanabilir. Ancak geç dönem kapsül kontraksiyonu oluşumu üzerine etkisini anlamak için uzun süreli ve daha detaylı analiz için immünohistokimyasal boyamaların yapıldığı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Meme implantları; mammoplasti; aselüler dermis; kapsüler kontraktür
ABSTRACT
 Objective: The number of breast augmentations and post-mastectomy breast reconstructions have dramatically increased since silicone breast implants were introduced in the past fifty years. However capsular contraction around silicone implants remains a challenging complication which is the most common reason for revision surgeries in these patients. Application of acellular dermal matrices (ADM) for prevention and treatment of implant- associated complications is performed by many surgeons. Therefore, the effects of Belladerm® (MTF,USA). on capsular contracture by defining the cellular dynamics of wound healing process are searched in this study. Material and Methods: We used 24 female Sprague-Dawley rats and divided the animals into one experimental group and one control group each consisting of 12 rats. In the control group, we used Slikongel-filled, smooth-surface implants. In the experimental group, we used the same implants of the control group, but unlike we wrapped the implants preoperatively with an acellular dermal matrix, with Belladerm® After 6 weeks, the implants and the resulting capsular tissue were removed and examined histologically. In the histopathological evaluation, the following parameters were scored: the intensity of polymorfonuclear and mononuclear leucocytes, and the thickness of synovial metaplasia zone around the implants. Results: Regarding the macroscopic comparison between the control group and the experimental group, it was demonstrated that implants wrapped with Belladerm had better integrated in the surrounding tissue. When analyzing the histiocyte count, which showed an acute inflammatory response at capsule formation, we could not detect any significant differences (p=0.93). However, there was a significant increase in granulocytes (p=0.26), lymphocytes (p<0.001) and synovial metaplasia zone (p<0.001) in the experimental group. Conclusion: Bimodal inflammatory cellular response is utmost important for capsuler tissue formation. We documented that Belladerm® integrates to the surrounding tissue and is not resorbed by host tissue cells at early stages after implant placement. However, the follow-up period should be longer to search the late effects of capsule formation and immunohistachemical stains are required for more exact results.

Keywords: Breast implants; mammaplasty; acellular dermis; capsular contracture
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