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A Comparison of the Effects of Epidural and Spinal Anesthesia With Ischemia-Reperfusion Injury on the Rat Transverse Rectus Abdominis Musculocutaneous Flap

Acar, Yusuf MD*; Bozkurt, Mehmet MD*; Firat, Ugur MD; Selcuk, Caferi Tayyar MD*; Kapi, Emin MD; Isik, Fatma Birgul MD§; Kuvat, Samet Vasfi MD; Celik, Feyzi MD; Bozarslan, Beri Hocaoglu MD#

doi: 10.1097/SAP.0b013e31824f220e

The purpose of this study is to compare the effects of spinal and epidural anesthesia on a rat transverse rectus abdominus myocutaneous flap ischemia-reperfusion injury model.

Forty Sprague-Dawley rats were divided into 4 experimental groups: group I (n = 10), sham group; group II (n = 10), control group; group III (n = 10), epidural group; and group IV (n = 10), spinal group. After the elevation of the transverse rectus abdominus myocutaneous flaps, all groups except for the sham group were subjected to normothermic no-flow ischemia for 4 hours, followed by a reperfusion period of 2 hours. At the end of the reperfusion period, biochemical and histopathological evaluations were performed on tissue samples.

Although there was no significant difference concerning the malonyldialdehyde, nitric oxide, and paraoxonase levels in the spinal and epidural groups, the total antioxidant state levels were significantly increased, and the total oxidative stress levels were significantly decreased in the epidural group in comparison to the spinal group. The pathological evaluation showed that findings related to inflammation, nuclear change rates and hyalinization were significantly higher in the spinal group compared with the epidural group.

Epidural anesthesia can be considered as a more suitable method that enables a decrease in ischemia-reperfusion injuries in the muscle flaps.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Center; †Department of Pathology, Dicle University Medical Faculty, Diyarbakir, Turkey; ‡Department of Plastic, Reconstructive and Aesthetic Surgery, Sirnak State Hospital, Sirnak; §Department of Biochemistry, Dicle University Medical Faculty, Diyarbakir; ∥Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul; ¶Department of Anaesthesia and Reanimation, Dicle University Medical Faculty, Diyarbakir; and #Department of Biochemistry, Cizre State Hospital, Sirnak, Turkey.

Received November 22, 2011, and accepted for publication, after revision, Febuary 6, 2012

Conflicts of interest and sources of funding: none declared.

Reprints: Caferi Tayyar Selcuk, MD, Department of Plastic Reconstructive and Aesthetic Surgery and Burn Center, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey. E-mail:

© 2013 by Lippincott Williams & Wilkins