Ulus Travma Acil Cerrahi Derg. 2016; 22(3): 205-214 | DOI: 10.5505/tjtes.2015.37888

Effects of transpositional muscle flaps transfected with vascular endothelial growth factor gene in the treatment of experimental osteomyelitis

Mahir Aliyev¹, Andaç Aykan², Muhitdin Eski², Nuri Arslan³, Bülent Kurt⁴, Mustafa Þengezer^2
1Department Of Plastic And Reconstructive Surgery, Military Hospital, Baku, Azerbaijan.
²Department Of Plastic And Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
³Department Of Nuclear Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
⁴Department Of Pathology, Gulhane Military Medical Academy, Ankara, Turkey.

BACKGROUND: Based on the angiogenetic and stimulating effects of bone healing and formation of vascular endothelial growth factor (VEGF), the present study was designed to assess the efficacy of VEGF gene application in the management of experimentally induced osteomyelitis.
METHODS: Thirty-two male Sprague Dawley rats were divided into 4 groups, and osteomyelitis was induced in the left tibial bones. Group 1 (n=8) was designated as a control group, and, after the induction of osteomyelitis, no treatment was applied for a period of 4 weeks. Group 2 (n=8) received only antibiotic treatment for 4 weeks following induction of osteomyelitis. In Group 3 (n=8), proximally pedicled gastrocnemius muscle flap was transposed over the osteomyelitic region following induction of osteomyelitis and antibiotic treatment applied for a 4-week period. In Group 4 (n=8), VEGF gene-transfected gastrocnemius muscle flap was transposed over the osteomyelitic region following identical antibiotic regimen applied for a 4-week period. For each group, body temperature, white blood cell (WBC) count, and radiological and histological parameters were evaluated.
RESULTS: Body temperature and WBC count remained high in the control group, but returned to normal in Groups 2, 3, and 4 after the third week of treatment. Statistical analysis of the total scores of radiological and histological results revealed significant differences between Groups 1 and 3, Groups 1 and 4, Groups 2 and 3, and Groups 2 and 4 (p<0.05). Regarding radiological parameters of abscess and sequester, and histological parameter of abscess, statistically significant differences were found between Group 4 and the other groups (p<0.05).
CONCLUSION: The efficacy of the VEGF gene-transfected muscle flap in the management of experimental osteomyelitis was proven by the results of the present study.

Keywords: Gastrocnemius, muscle flap, osteomyelitis, transfection; VEGF gene.

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Deneysel osteomyelit tedavisinde vasküler endotelial büyüme faktörü geni ile transfekte edilmiþ transpozisyonel kas flebinin etkinliði

Mahir Aliyev¹, Andaç Aykan², Muhitdin Eski², Nuri Arslan³, Bülent Kurt⁴, Mustafa Þengezer^2
1Asker Hastanesi, Plastik, Rekonstrüktif Ve Estetik Cerrahi, Bakü, Azerbaycan.
²Gulhane Askeri Týp Akademisi, Plastik, Rekonstrüktif Ve Estetik Cerrahi Ana Bilim Dalý, Ankara, Türkiye
³Gulhane Askeri Týp Akademisi, Nükleer Týp Ana Bilim Dalý, Ankara, Türkiye
⁴Gulhane Askeri Týp Akademisi, Patoloji Ana Bilim Dalý, Ankara, Türkiye

AMAÇ: Bu çalýþma, vasküler endotelyal büyüme faktörünün (VEGF) kemik iyileþmesi ve formasyonu üzerine anjiyogenetik ve indükleyici etkisine dayanarak, deneysel olarak oluþturulmuþ osteomyelitte VEGF gen uygulamasýnýn etkinliðini araþtýrmak için dizayn edildi.
GEREÇ VE YÖNTEM: Bu amaçla 32 adet erkek Sprague-Dawley cinsi sýçanýn sol tibiasýnda osteomyelit oluþturuldu ve denekler dört eþit gruba ayrýldý. Birinci grupta (kontrol grubu, n=8) dört hafta süre ile hiçbir tedavi uygulanmadý. Ýkinci grupta (n=8) dört hafta antibiyotik tedavisi uygulandý. Üçüncü grupta (n=8) proksimal pediküllü medial gastroknemius kas flebi osteomyelit alanýna transpoze edildi ve dört hafta antibiyotik tedavisi uygulandý. Dördüncü grupta (n=8) ise proksimal pediküllü medial gastroknemius kas flebi osteomyelit alanýna transpoze edildikten sonra plazmid içinde VEGF DNA’sý kas içine enjekte edildi ve dört hafta antibiyotik tedavisi uygulandý. Tüm gruplarda vücut ýsýsý, kan beyaz küre sayýsý incelendi, osteomyelit oluþturulan kemikler radyolojik ve histolojik açýdan deðerlendirildi.
BULGULAR: Vücut ýsýsý ve lökositoz deðerleri kontrol grubunda sürekli yüksekken, ikinci, üçüncü ve dördüncü gruplarda ise tedavinin üçüncü haftasýnda normal seviyelere döndüðü bulundu. Radyolojik ve histolojik deðerlerin toplam skorlarýnýn istatistiksel analizinde 1-3, 1-4, 2-3, ve 2 ile 4. gruplar arasýnda anlamlý fark tespit edildi (p<0.05). Radyolojik parametrelerden sadece apse ve sekestrum, histolojik parametrelerden ise sadece apse oluþumu açýsýndan dördüncü grup ve diðer gruplar arasýnda anlamlý fark saptandý (p<0.05).
TARTIÞMA: Elde edilen bulgular, VEGF geni ile transfekte edilmiþ kas flebinin, deneysel olarak, osteomyelit tedavisinde etkin olduðunu göstermiþtir.

Anahtar Kelimeler: Gastrokinemius, kas flebi, osteomyelit, transfeksiyon; VEGF; VEGF geni.

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