Eyuboglu Atilla Adnan, Akdemir Ovunc, Erbas Oytun, Isken Mustafa Tonguc, Zhang Feng, Lineaweaver William C
Arel University, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey.
Aydin University, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey.
Heliyon. 2024 Mar 1;10(5):e27448. doi: 10.1016/j.heliyon.2024.e27448. eCollection 2024 Mar 15.
Ischemia-reperfusion injury presents a substantial concern in various medical scenarios, notably in reconstructive surgery involving tissue flaps. Despite reports on the protective benefits of Propionyl-l-carnitine against ischemia-reperfusion injury, a thorough assessment of its efficacy in epigastric island flap models is currently lacking.
Sixteen male Sprague-Dawley rats underwent epigastric island flap surgery and were divided into two groups: a Propionyl-l-carnitine group that received intraperitoneal Propionyl-l-carnitine prior to ischemia induction and a sham group that received saline treatment. A comprehensive evaluation was performed including macroscopic, biochemical and histological assessments encompassing measurements of flap survival areas, lipid peroxidation (malondialdehyde), glutathione, myeloperoxidase, nitric oxide and peripheral neutrophil counts.
The Propionyl-l-carnitine group demonstrated significantly increased flap survival areas when compared to the sham group. Administration of Propionyl-l-carnitine led to reduced malondialdehyde levels and elevated glutathione levels indicating a reduction in oxidative stress. Furthermore, the Propionyl-l-carnitine group exhibited lower myeloperoxidase levels, higher nitric oxide levels and reduced peripheral neutrophil counts, suggesting a decrease in the inflammatory response. Histopathological analysis revealed decreased levels of inflammation, necrosis, polymorphonuclear leukocyte infiltration and edema in the Propionyl-l-carnitine group. Additionally, vascularity was enhanced in the Propionyl-l-carnitine group.
This study provides compelling evidence that Propionyl-l-carnitine administration effectively mitigates the deleterious effects of ischemia-reperfusion injury in epigastric island flaps. This is substantiated by the improved flap survival, diminished oxidative stress and inflammation, as well as the enhanced vascularity observed. Propionyl-l-carnitine emerges as a promising therapeutic intervention to enhance tissue flap survival in reconstructive surgery, warranting further exploration through larger-scale investigations.
缺血再灌注损伤在各种医疗场景中都是一个重大问题，尤其是在涉及组织瓣的重建手术中。尽管有报道称丙酰-L-肉碱对缺血再灌注损伤具有保护作用，但目前缺乏对其在腹壁岛状皮瓣模型中疗效的全面评估。
16只雄性Sprague-Dawley大鼠接受腹壁岛状皮瓣手术，并分为两组：丙酰-L-肉碱组在缺血诱导前腹腔注射丙酰-L-肉碱，假手术组接受生理盐水治疗。进行了全面评估，包括宏观、生化和组织学评估，涵盖皮瓣存活面积、脂质过氧化（丙二醛）、谷胱甘肽、髓过氧化物酶、一氧化氮和外周中性粒细胞计数的测量。
与假手术组相比，丙酰-L-肉碱组的皮瓣存活面积显著增加。丙酰-L-肉碱的给药导致丙二醛水平降低和谷胱甘肽水平升高，表明氧化应激降低。此外，丙酰-L-肉碱组的髓过氧化物酶水平较低，一氧化氮水平较高，外周中性粒细胞计数减少，表明炎症反应减轻。组织病理学分析显示丙酰-L-肉碱组的炎症、坏死、多形核白细胞浸润和水肿水平降低。此外，丙酰-L-肉碱组的血管生成增强。
本研究提供了令人信服的证据，表明丙酰-L-肉碱给药可有效减轻腹壁岛状皮瓣缺血再灌注损伤的有害影响。皮瓣存活率提高、氧化应激和炎症减轻以及观察到的血管生成增强证实了这一点。丙酰-L-肉碱成为一种有前途的治疗干预措施，可提高重建手术中组织瓣的存活率，值得通过大规模研究进一步探索。
