"An Experimental Study; Botox and Nicotine: How Effective Can It Be in Flap Surgery?"

In this study, the effects of nicotine and botulinum toxin (BTx) on perforator flap microcirculation were compared with the control group. We took 40 rats and cut a 6 cm x 6 cm perforator skin flap from the right superior deep epigastric artery. We then divided the rats into four groups: control, nicotine, BTx type A, and nicotine + BTx type A. We measured and statistically compared the necrosis rates of the flaps in the photos taken on the 7th day after surgery. We also evaluated tissue samples for gene expression, histopathology, and immunohistochemistry. In the BTx group (p = 0.01) and the nicotine + BTx group (p = 0.041), the necrotic area decreased significantly. There was a lot less CD34 and HIF-1alpha gene expression in the BTx (p = 0.009, p = 0.047) and nicotine + BTx (p = 0.001, p = 0.027) groups than in the control group. In the histopathological evaluation, we observed a significant increase in the number of newly formed vessels in the BTx group (p = 0.03) and nicotine + BTx group (p = 0.003). There was a significant increase in CD34 expression in the BTx group (p = 0.001) and the nicotine + BTx group (p = 0.02), as well as a significant increase in HIF-1 alpha expression in both the BTx group (p = 0.003) and the BTx + nicotine group (p = 0.05). In this experimental study, we believe that applying BTx alone or in combination with nicotine to rats with perforator flaps may be beneficial in terms of flap viability and microcirculation. Level V (Animal/Experimental Study).