Yavuz E, Cengiz I Z, Arslan A, Eser C
Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey.
Ann Chir Plast Esthet. 2025 Sep;70(5):417-425. doi: 10.1016/j.anplas.2025.01.008. Epub 2025 Jan 24.
Hydrogen sulfide (HS) is a widely studied gasotransmitter, and its protective effect against ischemia-reperfusion damage has been explored in several studies. Therefore, a requirement exists for a comprehensive study about HS effects on ischemia-reperfusion damage in flap surgery. The aim of this study is to examine the effect of hydrogen sulfide by creating ischemia-reperfusion injury in the vascular-stemmed island flap prepared from the rat groin area.
"Wistar albino" rats weighing between 250 and 300 grams were divided into 4 groups (group 1, group 2, group 3, group 4). Each group was divided into 2 subgroups: subgroup A (control) and subgroup B (HS). In each group, skin flaps were elevated as an island flap with a superficial epigastric artery pedicle, 6 × 4cm from the groin area. In subgroup B (HS), liquid hydrogen sulfide was injected through the tail vein 20minutes before ischemia at a final concentration of 10μM. Femoral artery and vein blood flows were stopped with separate microclips and left in ischemia, according to the planned ischemia hours of the flaps: group 1 as 1 hour, group 2 as 2hours, group 3 as 3hours, and group 4 as 6hours. Later, microclips were removed, and blood flow restored again. After 12hours of reperfusion, the rats were sacrificed by cervical dislocation, and tissue samples were taken. From the samples taken, neutrophil count in ischemic tissue, MDA (malondialdehyde) measurement, and damage in the tissue were evaluated by electron microscopy.
On electron microscopy inspection at all hours (1, 2, 3, and 6), hydrogen sulfide was found to provide protection against ischemia, reperfusion damage, and apoptosis at the cellular level. There was a statistically significant (P=0.035) decrease in the tissue neutrophil count at the 1st, 2nd, and 3rd hours. In the tissue MDA measurement, a statistically significant (P=0.026) decrease in hydrogen sulfide was detected at the first hour. There was no statistically significant difference in the 6th hour tissue neutrophil count and 2nd, 3rd, and 6th hour tissue MDA measurement.
Electron microscopy results in this study showed that hydrogen sulfide had antiapoptotic effects on reperfusion damage in skin flaps at all hours. However, the neutrophil counts showed it had cytoprotective and anti-inflammatory properties during the 1st, 2nd, and 3rd hours following ischemia, but not during the 6th hour. Tissue MDA levels indicate that HS mitigates significant I/R injury during the 1st hour but not in the subsequent 2nd, 3rd, and 6th hours. These results led to the hypothesis that, in order to offer a strong enough protective effect against I/R damage, HS should be administered repeatedly or at varying concentrations. After more research on how HS affects skin flaps, we believe that it can be used in plastic surgery practices.
硫化氢（HS）是一种被广泛研究的气体信号分子，其对缺血再灌注损伤的保护作用已在多项研究中得到探索。因此，需要对HS在皮瓣手术中对缺血再灌注损伤的影响进行全面研究。本研究的目的是通过在大鼠腹股沟区制备的带血管蒂岛状皮瓣中制造缺血再灌注损伤，来研究硫化氢的作用。
体重在250至300克之间的“Wistar白化”大鼠被分为4组（第1组、第2组、第3组、第4组）。每组又分为2个亚组：亚组A（对照组）和亚组B（HS组）。在每组中，以腹股沟区的腹壁浅动脉为蒂掀起6×4cm的岛状皮瓣。在亚组B（HS组）中，在缺血前20分钟经尾静脉注射液态硫化氢，终浓度为10μM。根据皮瓣计划的缺血时间，用单独的微血管夹阻断股动脉和静脉血流，使其处于缺血状态：第1组为1小时，第2组为2小时，第3组为3小时，第4组为6小时。之后，移除微血管夹，血流再次恢复。再灌注12小时后，通过颈椎脱臼处死大鼠，并采集组织样本。从采集的样本中，评估缺血组织中的中性粒细胞计数、丙二醛（MDA）测量值以及通过电子显微镜观察组织损伤情况。
在所有时间点（1小时、2小时、3小时和6小时）的电子显微镜检查中，发现硫化氢在细胞水平上对缺血、再灌注损伤和细胞凋亡具有保护作用。在第1小时、第2小时和第3小时，组织中性粒细胞计数有统计学意义的下降（P = 0.035）。在组织MDA测量中，第1小时检测到硫化氢有统计学意义的下降（P = 0.026）。在第6小时组织中性粒细胞计数以及第2小时、第3小时和第6小时组织MDA测量中，没有统计学意义的差异。
本研究的电子显微镜结果表明，硫化氢在所有时间点对皮瓣再灌注损伤均具有抗凋亡作用。然而，中性粒细胞计数显示，在缺血后的第1小时、第2小时和第3小时它具有细胞保护和抗炎特性，但在第6小时则没有。组织MDA水平表明，HS在第1小时减轻了显著的心/再灌注损伤，但在随后的第2小时、第3小时和第6小时则没有。这些结果引发了一个假设，即要对缺血/再灌注损伤提供足够强的保护作用，HS应重复给药或采用不同浓度给药。在对HS如何影响皮瓣进行更多研究之后，我们相信它可用于整形外科实践。
