Uso do laser de baixa intensidade como potencializador da cicatrização de retalhos cutâneos tubulares de padrão subdérmico diretos empregados em coelhos (Oryctolagus cuniculus)
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Data
2018-06-22
Autores
Barata, Julielton de Souza
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Atualmente o retalho tubular de padrão subdérmico destinado à reconstrução da extremidade de membros é realizado de forma indireta, implicando em um processo de reconstrução composto por múltiplas fases de cirurgia. Além dos riscos inerentes a sucessivos procedimentos anestésicos, este processo pode levar ao aumento da morbidade do paciente e elevar o custo do tratamento, sendo que consequentemente, observa-se a subutilização da técnica na rotina em Medicina Veterinária. O presente estudo teve o objetivo de avaliar a ação do laser de baixa intensidade na preservação da vitalidade tecidual de retalhos de padrão subdérmico aplicados de forma direta para a reconstrução de defeitos na extremidade do membro torácico em coelhos. Quarenta coelhos foram divididos aleatoriamente em dois grupos com 20 animais cada, assim especificados: Grupo A – submetidos à técnica de retalho tubular de padrão subdérmico tratados com laser a cada 48 horas (GT) e Grupo B – submetidos ao mesmo procedimento cirúrgico, porém não receberam o tratamento com laser (GC). Os dois grupos foram subdivididos em quatro grupos com cinco animais cada, sendo nesses subgrupos realizado avaliações macroscópicas e eutanásia em diferentes dias no pós-operatório (4, 8, 16, e 22 dias de pós-operatório). Após a obtenção do retalho tubular, o material foi clivado na região de interface distal entre o retalho e leito receptor para avaliação microscópica. A análise dos dados evidenciou que tanto os animais do grupo GL quanto os animais do grupo GC apresentaram a maior parte do retalho tubular viável, mas a presença de necrose foi visualizada de forma frequente nos animais do GC aos 4 (p=0,0384) e 8 (p=0,0384) dias de pós-operatório. Houve também associação significativa (p<0,0001) entre neovascularização discreta e ausência de necrose nos animais do GL aos 4 dias. Aos 22 dias de pós-operatório a ausência de neovascularização estava associada (p<0,0001) a necrose discreta nos animais do GC. Dessa forma, é possível afirmar que o retalho tubular de padrão subdérmico direto pode ser empregado em coelhos, mesmo com um ângulo de rotação maior que 90 graus. Entretanto, há a necessidade de busca por estudos que comprovem a viabilidade da técnica empregada em outras espécies. O laser de baixa intensidade na dose e frequência empregadas neste estudo se mostrou eficaz em promover neovascularização e evitar complicações relacionadas a hipóxia e inflamação tecidual
The tubular flap of the subdermal pattern applied for limb reconstruction is performed indirectly, implying in multiple steps reconstruction process. Beyond the risks inherent to several anesthetic procedures, the whole process can lead to an increase in patient’s morbidity and in total cost of treatment. Consequently, it could lead to the underutilization of the technique in the Veterinary Medicine routine. The aim of the present study was evaluate the action of low intensity laser in the preservation of the tissue vitality of subdermal patches applied directly to the reconstruction of defects at the extremity of the thoracic limb of rabbits. Forty rabbits were randomly divided into two groups with 20 animals each. Group A - submitted to the technique of tubular flap of subdermal pattern treated with laser every 48 hours (LG) and Group B - submitted to the same surgical procedure, but didn’t undergo to the laser treatment (CG). The two groups were further subdivided into four groups with five animals each, and in each subgroups, the patients were submmited to macroscopic evaluations and euthanasia procedure were performed on different postoperative days (4, 8, 16, and 22 postoperative days). After obtaining the tubular flap, the material was cleaved at the distal interface region between the flap and recipient bed for microscopic evaluation. Data analysis showed that both TG and CG presented viability on the tubular flap, but the presence of necrosis was frequently seen in CG animals at 4 (p = 0.0384) and 8 (p = 0.0384) postoperative days. There was also a significant association (p <0.0001) between mild neovascularization and absence of necrosis in TG animals at 4 postoperative days. At 22 postoperative days the absence of neovascularization was associated (p <0.0001) with the mild necrosis in CG. In conclusion, it is possible to state that the tubular flap of direct subdermal pattern can be used in rabbits. However, it is necessary more studies to prove the viability of this technique in other species. The low intensity dose and frequency laser used in this study was shown to be effective in promoting neovascularization and avoid complications related to hypoxia and tissue inflammation.
The tubular flap of the subdermal pattern applied for limb reconstruction is performed indirectly, implying in multiple steps reconstruction process. Beyond the risks inherent to several anesthetic procedures, the whole process can lead to an increase in patient’s morbidity and in total cost of treatment. Consequently, it could lead to the underutilization of the technique in the Veterinary Medicine routine. The aim of the present study was evaluate the action of low intensity laser in the preservation of the tissue vitality of subdermal patches applied directly to the reconstruction of defects at the extremity of the thoracic limb of rabbits. Forty rabbits were randomly divided into two groups with 20 animals each. Group A - submitted to the technique of tubular flap of subdermal pattern treated with laser every 48 hours (LG) and Group B - submitted to the same surgical procedure, but didn’t undergo to the laser treatment (CG). The two groups were further subdivided into four groups with five animals each, and in each subgroups, the patients were submmited to macroscopic evaluations and euthanasia procedure were performed on different postoperative days (4, 8, 16, and 22 postoperative days). After obtaining the tubular flap, the material was cleaved at the distal interface region between the flap and recipient bed for microscopic evaluation. Data analysis showed that both TG and CG presented viability on the tubular flap, but the presence of necrosis was frequently seen in CG animals at 4 (p = 0.0384) and 8 (p = 0.0384) postoperative days. There was also a significant association (p <0.0001) between mild neovascularization and absence of necrosis in TG animals at 4 postoperative days. At 22 postoperative days the absence of neovascularization was associated (p <0.0001) with the mild necrosis in CG. In conclusion, it is possible to state that the tubular flap of direct subdermal pattern can be used in rabbits. However, it is necessary more studies to prove the viability of this technique in other species. The low intensity dose and frequency laser used in this study was shown to be effective in promoting neovascularization and avoid complications related to hypoxia and tissue inflammation.
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Palavras-chave
Angiogênese, Cirurgia reconstrutiva, Laserterapia, Retalho tubular