Plastic Reconstructive and Aesthetic Surgery Department, State Research and Training Hospital, Erzurum, Turkey.
J Plast Reconstr Aesthet Surg. 2012 Feb;65(2):240-8. doi: 10.1016/j.bjps.2011.09.005. Epub 2011 Sep 22.
Denervation decreases skeletal muscle's energy needs and alters its metabolism and circulation. Our study was designed in two stages to investigate the effects of surgical and chemical denervation on the ischaemia/reperfusion injury of skeletal muscle. Degenerative histological analysis, apoptosis scoring and tissue levels of malonyl-di-aldehyde (MDA) and nitric oxide end products (NOx) were studied to understand the extent of ischaemia/reperfusion injury of skeletal muscles.
MATERIALS-METHODS: In the first stage, the effect of surgical denervation was investigated in four groups each containing six rats. The right biceps femoris muscle was used as the experimental muscle flap model. In the control group, only the ischaemia/reperfusion cycle was applied. Ischaemia was created by a tourniquet strictly wrapping the right lower extremity for 4 h. After ischaemia, the tourniquet was cut, and the extremity was reperfused for another 4 h. In the experimental groups, surgical denervation was applied 1 day, 7 days and 30 days before the ischaemia/reperfusion cycle. On the second stage, the effect of chemical denervation with botulinum toxin type-A (BoNT-A) was investigated in three groups, each containing six rats. In the experimental groups, BoNT-A was applied 1 day, 7 days and 30 days before the ischaemia/reperfusion cycle.
The control group had the worst scores in all experiment parameters. Degenerative histology and apoptosis scores were significantly better in groups to which BoNT-A and SD were applied 1 or 7 days before the ischaemia/reperfusion cycle. Regarding tissue levels of MDA and NOx, the experiment groups had significantly better scores comparing to the control group.
Both surgical and chemical denervation applied before muscle transfer increased muscle ischaemia tolerance. With similar experimental outcomes, denervation with BoNT-A can be preferred to surgical denervation because of its abundant clinical availability and it can be applied without any secondary surgery.
去神经支配可降低骨骼肌的能量需求，并改变其代谢和循环。我们的研究分为两个阶段，旨在研究外科和化学去神经支配对骨骼肌缺血/再灌注损伤的影响。通过退行性组织学分析、细胞凋亡评分以及丙二醛 (MDA) 和一氧化氮终产物 (NOx) 的组织水平来研究骨骼肌缺血/再灌注损伤的程度。
在第一阶段，研究了外科去神经支配对四组（每组 6 只大鼠）的影响。右侧股二头肌用作实验性肌肉皮瓣模型。在对照组中，仅进行缺血/再灌注循环。通过严格包裹右下肢的止血带产生缺血，持续 4 小时。缺血后，松开止血带，肢体再灌注 4 小时。在实验组中，在缺血/再灌注循环前 1 天、7 天和 30 天进行外科去神经支配。在第二阶段，研究了肉毒杆菌毒素 A（BoNT-A）的化学去神经支配对三组（每组 6 只大鼠）的影响。在实验组中，在缺血/再灌注循环前 1 天、7 天和 30 天应用 BoNT-A。
在所有实验参数中，对照组的评分最差。与缺血/再灌注循环前 1 天或 7 天应用 BoNT-A 和 SD 的实验组相比，退行性组织学和细胞凋亡评分显著改善。关于 MDA 和 NOx 的组织水平，实验组与对照组相比，评分明显更好。
在肌肉转移前进行外科和化学去神经支配均可增加肌肉的缺血耐受性。由于 BoNT-A 具有丰富的临床可用性，并且可以无需进行任何二次手术应用，因此其效果与外科去神经支配相似，因此可以优先选择 BoNT-A 进行去神经支配。
