Utilização de flap de omento para indução da cicatrização de enxertos cutâneos em suínos
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Data
2017-10-27
Autores
Pascoli, Ana Lucia de Carvalho Rosa
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Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi verificar a indução da cicatrização de enxertos cutâneos em malha após a utilização de flap de omento transposto através de túnel no subcutâneo até o leito receptor em suínos, e observar as alterações no pós-operatório, em relação à cicatrização dos enxertos entre os grupos (grupo omento e grupo controle). Além disso, foi realizada a avaliação macroscópica (dias 3, 7, 10 e 14) e microscópica (14° dia) do enxertos dos grupos estudados. Foram utilizados 19 suínos e em cada animal foram realizadas duas feridas cirúrgicas de 4,0 x 4,0 cm, na região ventral do tórax, entre as mamas torácicas (M1 e M2). No lado direito (LD) foi colocada à porção de pele (enxerto) removida do lado esquerdo (LE), sem a presença do flap de omento entre o enxerto e o leito receptor. No LE, foi fixado um flap de omento entre o enxerto cutâneo removido do LD e o leito receptor. As avaliações macroscópicas dos enxertos foram realizadas considerando algumas características, como exsudação, coloração, edema, deiscência, tecido desvitalizado, secreção e integração do enxerto. Já nas microscópicas, foram avaliadas à proliferação vascular/angiogênese, células mononucleares, células polimorfonucleares, proliferação fibroblástica, colagenização, reepitelização, queratinização, hemorragia e edema. Em relação às avaliações macroscópicas foi verificado que o edema diminuiu gradativamente, sendo menor no dia 14, quando comparado ao dia 3 (p=0,006), em ambos os grupos. A deiscência foi maior no dia 10 em comparação aos demais dias (p=0,012), em ambos os grupos. O grupo controle apresentou maior incidência de tecido desvitalizado (p=0,004) que o grupo omento, porém sem diferença (p=0,213) entre os diferentes dias de avaliação. Foi verificada a presença de tecido desvitalizado em 32% dos enxertos com omento e 53% no grupo controle. Nas demais avaliações macroscópicas não foram observadas diferenças estatísticas. Na avaliação microscópica, foi observada que o grupo omento apresentou maior colagenização (p=0,017), reepitelização (p=0,024), queratinização (p=0,04) e menor edema (p=0,013), quando comparado ao grupo controle. Concluiu-se com esse estudo que enxertos cutâneos em malha evoluíram satisfatoriamente em suínos, mesmo em leito receptor recém-criado e sem presença de tecido de granulação, desde que vascularizado e que o flap de omento propiciou melhores resultados macro e microscópicos relativos à integração do enxerto, com maior qualidade e segurança.
The objective of this study was to verify the induction of cicatrization of free skin grafts after the use of omental flap transposed through the subcutaneous tunnel to the recipient bed in pigs, and to verify the changes observed in the postoperative period, regarding the healing between the groups (omentum group and control group). In addition, macroscopic evaluation (days 3, 7, 10 and 14) and microscopic evaluation (day 14) of the grafts between the groups were performed. Nineteen pigs were used, each animal received two surgical wounds of 4.0 x 4.0 cm, in the ventral region of the chest, between the thoracic mammary gland (M1 and M2). The graft removed from the left side (LS) was placed on the right side (RS) without the presence of the omental flap between the graft and the recipient bed. On the LS, an omental flap was fixed between the cutaneous graft removed from the RS and the recipient bed. Graft evaluations were performed considering some characteristics, such as exudation, skin color, edema, dehiscence, devitalized tissue, secretion and graft integration. Microscopic evaluations considered vascular proliferation/angiogenesis, mononuclear cells, polymorphonuclear cells, fibroblast proliferation, collagenization, re-epithelization, keratinization, hemorrhage and edema. Regarding the macroscopic evaluations, it was verified that the edema gradually decreased, being lower on day 14, when compared to day 3 (p=0.006), in both groups. The dehiscence was higher on day 10, compared to the other days (p=0.012), in both groups. The control group had a higher incidence of devitalized tissue (p=0.004) than the omentum group, but without difference (p=0.213) between the different evaluation days. The presence of devitalized tissue was verified in 32% of the grafts with omentum, and 53% in the control group. In the other macroscopic evaluations, no statistical differences were observed. In the microscopic evaluation, it was observed that the omentum group presented higher collagenization (p=0.017), re-epithelialization (p=0.024), keratinization (p=0.04) and lower edema (p=0.013), when compared to the control group. It was concluded in this study that mesh skin grafts evolved satisfactorily in pigs, even in newly created recipient bed and without granulation tissue, provided that vascularized and that the flap of omentum provided better macro and microscopic results regarding the integration of the graft, with higher quality and safety.
The objective of this study was to verify the induction of cicatrization of free skin grafts after the use of omental flap transposed through the subcutaneous tunnel to the recipient bed in pigs, and to verify the changes observed in the postoperative period, regarding the healing between the groups (omentum group and control group). In addition, macroscopic evaluation (days 3, 7, 10 and 14) and microscopic evaluation (day 14) of the grafts between the groups were performed. Nineteen pigs were used, each animal received two surgical wounds of 4.0 x 4.0 cm, in the ventral region of the chest, between the thoracic mammary gland (M1 and M2). The graft removed from the left side (LS) was placed on the right side (RS) without the presence of the omental flap between the graft and the recipient bed. On the LS, an omental flap was fixed between the cutaneous graft removed from the RS and the recipient bed. Graft evaluations were performed considering some characteristics, such as exudation, skin color, edema, dehiscence, devitalized tissue, secretion and graft integration. Microscopic evaluations considered vascular proliferation/angiogenesis, mononuclear cells, polymorphonuclear cells, fibroblast proliferation, collagenization, re-epithelization, keratinization, hemorrhage and edema. Regarding the macroscopic evaluations, it was verified that the edema gradually decreased, being lower on day 14, when compared to day 3 (p=0.006), in both groups. The dehiscence was higher on day 10, compared to the other days (p=0.012), in both groups. The control group had a higher incidence of devitalized tissue (p=0.004) than the omentum group, but without difference (p=0.213) between the different evaluation days. The presence of devitalized tissue was verified in 32% of the grafts with omentum, and 53% in the control group. In the other macroscopic evaluations, no statistical differences were observed. In the microscopic evaluation, it was observed that the omentum group presented higher collagenization (p=0.017), re-epithelialization (p=0.024), keratinization (p=0.04) and lower edema (p=0.013), when compared to the control group. It was concluded in this study that mesh skin grafts evolved satisfactorily in pigs, even in newly created recipient bed and without granulation tissue, provided that vascularized and that the flap of omentum provided better macro and microscopic results regarding the integration of the graft, with higher quality and safety.
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Palavras-chave
angiogênese, reconstrutiva, retalho, vascularização, angiogenesis, reconstructive, flap, vascularization