Antikoagüle edilmiş ve diabetik denek hayvanlarında diyot lazerin yara iyileşmesi ve kanama kontrolü üzerine etkilerinin incelenmesi
Lasers have a significant role in oral and maxillofacial surgery. There are several types of lasers available in the field of oral and maxillofacial surgery, of which diode laser is widely used in minor surgeries. A common complication of diabetes mellitus, which is a kind of metabolic disease, is poor wound healing. Blood coagulation disorders cause excessive bleeding during the surgical procedures. This study aims to assess the effects of diode laser, electrosurgery and scalpel on wound healing process and hemostasis in rats divided into three groups as: Streptozotocin-induced diabetic, anticoagulated and control group of rats.In this study, 42 adult male Wistar albino rats, weighing between 250?300 grams, are divided into three groups as control, diabetic and anticoagulated. Each main group is divided into two subgroups with respect to the time of excision. Excisions are performed on each rat on days 4 and 15. These subgroups are also divided into three groups based on the method of incision as diode laser, electrosurgery and scalpel. Experimental diabetes mellitus is induced by intraperitoneal injection of a single dose (35 mg/kg) streptozotocin. Anticoagulation is administered by oral gavage of single dose warfarin as 0,5 mg/kg followed by subsequent dosing at 24 hours intervals as 0,1 mg/kg for seven days.Three full thickness skin incisions, 1 cm in length, are made on the dorsum of each rat. The sequenced incisions are created with the diode laser, electrosurgery and scalpel. All wounds are allowed to go through a period of secondary healing and excised on day-5 and day-14 and rats are sacrificed. All excisions were sectioned for histopathological and histomorphometrical evaluation. Surgical brain pads are utilized for the evaluation of hemostasis during incisions.In all three groups, exuda and fibrin grades are higher on the day?5 sections compared to those of day?14. Medium-dense inflammation is seen in the day?5 sections whereas a slight grade of inflammation is noted in the day?14 sections. Vascularised and fibrous granulation tissues are examined respectively in the day?5 sections and day?14 sections.Inflammation grade of the day?5 sections of the wounds incised by scalpel in the diabetic group is significantly lower than the other two groups. The granulation tissue grade of the day?5 sections of the diode laser wounds in the control group is significantly lower than the scalpel and electrosurgery groups.Histomorphometrical evaluation reveals that defect area and the deepithelization width of the day?5 sections of the scalpel wounds in the diabetic and control groups are significantly lower than the diode laser and electrosurgical wounds.In all three groups, granulation tissue in the day?14 sections of the wounds incised by diode laser, shows less fibrosis than the other two groups whereas the inflammation grade is higher. Surface concavity of the electrosurgical wounds is higher in the day?14 sections of the control group. In the diabetic and anticoagulated groups, the defect area and deepithelization width of the day?14 sections of the wounds incised by diode laser are higher than the electrosurgery and scalpel groups.Bleeding is only observed during the scalpel incisions. Hemostasis is maintained by diode laser and electrosurgery.It is observed that wound healing is delayed for the day?14 incisions made by diode laser as compared to electrosurgical incisions. However, in the electrosurgery group, scar tissue formation is widespread than scalpel group. Briefly, scalpel incisions are healed with less scar tissue compared to the other two groups.Although delayed tissue healing is observed on diode laser incisions, diode laser is superior to the other methods in terms of its hemostatic capabilities on patients undergoing anticoagulated drug treatment. Further investigation is required due to the variation in the number of parameters that needs to be considered in the laser-tissue interaction and the efficiency of these parameters.