Adolescent ; Adult ; Aged ; Compartment Syndromes ; diagnosis ; Extremities ; blood supply ; Fascia ; blood supply ; Female ; Humans ; Male ; Middle Aged ; Oxygen ; blood

OBJECTIVETo investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.

METHODSThe deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. Free deep inferior epigastric perforator flaps were harvested in flow- through manners to reconstruct associated arterial defect in the wound. The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.

RESULTSFrom December 2011 to September 2012, 5 patients with large defects at extremities were treated. The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. The wound defects ranged form 11 cm x 5 cm to 30 cm x 11 cm. And the flap size ranged from 13 cm x7 cm to 33 cm x 13 cm. All flaps survived completely. The recipient arteries were all bypassed well documented by color Doppler examinations. All cases had 12-24 months' follow-up period. The flaps had good appearance and high aesthetic satisfactory(100%). 12 months after operations, sensation assessment were all S3+, and the Enneking score ratios were 82%-95% ,with 87.2% in average.

CONCLUSIONSFlow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities. The flaps can also be designed in transverse or oblique mode for clinical application.

Aged ; Arteries ; Epigastric Arteries ; Esthetics ; Extremities ; blood supply ; surgery ; Humans ; Leg Injuries ; surgery ; Perforator Flap ; blood supply ; Reconstructive Surgical Procedures

Chinese medicine (CM) theories attach great importance to the interaction between the human body and the environment. From this entry point, based on a great number of related CM literatures and knowledge of modern medicine, this paper investigated the essence of chilliness and cold limbs of yang deficiency syndrome. The differences on cognition and solution to this problem between CM theory and modern medicine theory were also analyzed. Firstly, the close relationship between the CM concepts of yang deficiency, "external cold", and winter was put forward after a review of yang deficiency in CM scripture Huangdi Neijing. Chilliness and cold limbs of yang deficiency patients was believed to be highly similar to the body state of "external cold" of healthy people in winter. Secondly, the state of "external cold" was described as a reduction of body surface blood flow (heat) with references to the adaptability to cold stimulation. Then according to a collection of physiological and pathological factors which may cause such reduction, we proposed that the essence of chilliness and cold limbs of yang deficiency patients may probably be the state of reduction of body surface blood flow (heat) due to some pathological factors already known as heart failure, poor circulation, and thyroid dysfunction. Thirdly, by using the method of "syndrome differentiation through formula effects assessment", this recognition was confirmed because the pharmacological activities of cardiotonic or peripheral vasodilating, or surface temperature increasing were found in a great number of single medicines and prescriptions applied to yang deficiency syndrome in CM.
Cold Temperature ; Energy Metabolism ; Extremities ; blood supply ; Humans ; Medicine, Chinese Traditional ; methods ; Yang Deficiency ; Yin-Yang

OBJECTIVE: To review the research progress of supraclavicular vascularized lymph node transfer (VLNT). METHODS: The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized. RESULTS: The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction. CONCLUSION There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.
Humans ; Quality of Life ; Lymphedema/surgery* ; Lymph Nodes/blood supply* ; Lymphatic Vessels/surgery* ; Extremities

AIMTo explore the effects of limb ischemic preconditioning (LIP) on cerebral ischemia/reperfusion injuries.

METHODSThirty six wistar rats, of which bilateral vertebral arteries were occluded permanently, were randomly divided into the following 6 groups: control group, cerebral ischemic group, limb ischemic group, LIP 0 d group (cerebral ischemia was given immediately after LIP), LIP 1 d group (cerebral ischemia was given 1 d after LIP) and LIP 2 d group (cerebral ischemia was given 2 d after LIP). Global cerebral ischemia was performed by four vessels occlusion in rats. LIP was performed by occluding the bilateral femoral arteries for 10 min 3 times in a interval of 10 min. The histological grade and pyramidal neuronal density in the CA1 hippocampus were measured to quantitate the degree of hippocampal injury under thionin staining.

RESULTSThe histological grade was increased and the pyramidal neuronal density was decreased in the CA1 hippocampus of the cerebral ischemic group (P < 0.01). The damage of the CA1 hippocampus in LIP 0 d group was significantly diminished, which represented by decreased histological grade and increased neuronal density compared with the cerebral ischemic group (P < 0.01). But the CA1 hippocampus still showed obvious injuries in the LIP 1 d and LIP 2 d group.

CONCLUSIONLIP performed immediately prior to cerebral ischemia could confer obvious protective effects on CA1 hippocampus against cerebral ischemia/reperfusion injuries. But LIP performed 1 d and 2 d prior to cerebral ischemia could not afford the protection against injuries induced by cerebral ischemia/reperfusion.

Animals ; Brain Ischemia ; prevention & control ; Extremities ; blood supply ; Hippocampus ; blood supply ; Ischemic Preconditioning ; methods ; Rats ; Rats, Wistar ; Reperfusion Injury ; prevention & control

AIMTo study the effect of ischemic preconditioning on lung injury following ischemia/reperfusion (I/R) in the hind limbs of rats.

METHODSWistar rats were randomly divided into four groups (n=8): control group,limbs ischemia/reperfusion (LI/R) group, ischemia preconditioning (IPC) group and L-NAME group. At the end of the experiment, blood/gas analysis and the contents of serum MDA, NO, ET and lung tissue MDA, NO, ET, MPO were measured. Meanwhile, lung index and W/D) of lung were measured.

RESULTSAfter the rats' hind limbs suffered ischemia/reperfusion, the level of PaO2 decreased and the values of W/D, LI, MPO of the lung issure and MDA, NO, ET of plasma and lung all increased significantly in the LI/R group; but the ratio of NO/ET decreased. Compared with LI/R group, the contents of NO and ratio of NO/ET increased but other parameters decreased in the IPC group. Compared with IPC group, the contents of NO and ratio of NO/ET decreased, but other parameters increased in the L-NAME group.

CONCLUSIONThe IPC can attenuate lung injury following IR in the hind limbs of rats, which may correlated with the increase of NO.

Acute Lung Injury ; prevention & control ; Animals ; Extremities ; blood supply ; Ischemia ; physiopathology ; Ischemic Preconditioning ; methods ; Lung ; blood supply ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; metabolism ; prevention & control

AIMTo investigate the protective effect of exogenous carbon monoxide (CO) on the liver injury induced by ischemia/reperfusion (I/R) of hind limbs in rats.

METHODS100 SD rats were divided randomly into sham operated group (S), S+ CO group (SC), I/R group (I/R), I/ R+ CO group (RC). A rat model of ischemia in hind limbs and the reperfusion liver injury was established with the occlusion of the femoral arteries for 4 h and re-opening for 6 - 72 h, 10 d. The rats in SC and RC groups were exposed to air containing CO (the volume traction of CO: 0.05%) for 2 h before and after reperfusion or the corresponding control time point, while the other two groups were exposed to the routine air. The pathologic changes of liver tissue were morphologically observed by HE stain. Serum GPT activity was tested by Automatic Biochemical Analyzer. The percentage of apoptosis, expression levels of bax and bcl-2 protein in liver tissue were detected by Flow Cytometry.

RESULTSThere was no difference between S and SC groups. Compared with SC group: (1) Pathological changes in liver tissue were significant in I/R and RC groups. (2) The serum GPT activity of I/R and RC groups was obviously increased. (3) In IR and RC groups, the percentage of apoptosis in liver tissue was all significantly increased. (4) The bax expression level was significantly increased. Compared RC group with I/R group: (1) Pathological change was slight. (2) The serum GPT activity was depressed. (3) The percentage of apoptosis and expression level of bax protein in liver tissue were depressed. (4) The expression level of bcl-2 protein in liver tissue was increased.

CONCLUSIONExogenous CO could attenuate liver tissue injury induced by limbs I/R in rats.

Animals ; Carbon Monoxide ; pharmacology ; Extremities ; blood supply ; Female ; Liver ; blood supply ; pathology ; Liver Diseases ; etiology ; pathology ; prevention & control ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; complications ; prevention & control

Animals ; Extremities ; blood supply ; Heparin ; pharmacology ; Male ; Mesentery ; blood supply ; Microcirculation ; drug effects ; Rats ; Rats, Wistar ; Reperfusion Injury ; Splanchnic Circulation ; drug effects

OBJECTIVEIn this study, we try to find the better protocol of limb ischemia postconditioning by observing different protective effects of limb ischemic postconditioning (different strength and time windows in rabbits).

METHODS42 healthy New Zealand rabbits were randomly divided into 7 groups (n = 6): Sham; Control (CON); Skeletal muscle postconditioning (SP); 6 min-delayed skeletal muscle postconditioning (6M-DSP); 1 min-delayed skeletal muscle postconditioning (1M-DSP); Strengthen skeletal muscle postconditioning (SSP); Weakened skeletal muscle postconditioning (WSP). Acute ischemia/reperfusion (I/R) model was induced by 45 minutes occlusion on left circumflex coronary artery (LCX) and 2 hours reperfusion in all anesthetized open-chest rabbits except the Sham. Limb ischemia was induced by external iliac arteries occlusion and reperfusion through artery clamps. The extent of myocardial infarction was assessed by triphenyltetrazolium (TTC) staining. Blood serum creatine kinase (CK) activity and lactate dehydrogenase (LDH) activity were measured at baseline,the end of ischemia, after 1 hour and 2 hours of reperfusion respectively.

RESULTSCompared with the CON, the weight ratio and area ratio of myocardial infarction size were significantly decreased by 49.97% and 43.78% in SP, by 42.32% and 42.68% in 1M-DSP, by 48.36% and 48.86% in SSP (P < 0.05). But there was no significant difference between SP and 1M-DSP and SSP (P > 0.05). Otherwise, compared with the CON, myocardial infarct size was not significantly reduced in 6M-DSP or WSP (P > 0.05). The change of CK was similar to the trend of myocardial infarct size.

CONCLUSIONThe limb ischemia strength of 5 mini/1 minR x 1 cycle could significantly reduce the myocardial ischemia/ reperfusion injury in rabbits, if it was achieved before myocardial reperfusion.

Animals ; Extremities ; blood supply ; Ischemic Postconditioning ; methods ; Male ; Muscle, Skeletal ; blood supply ; Myocardial Infarction ; pathology ; Myocardial Reperfusion Injury ; pathology ; prevention & control ; Myocardium ; metabolism ; Rabbits

OBJECTIVE: To investigate the liver protection mechanisms of MAPK signaling pathway of limb ischemia preconditioning in the late phase. METHODS: Thirty-six adult male New Zealand white rabbits, weighing 1.8-2.0 kg, were randomly divided equally into 3 groups: group C (sham operation), group L (liver ischemia-reperfusion 24 h after limb ischemia preconditioning), group IR (liver ischemia-reperfusion without limb ischemia preconditioning). Serum alanine transaminase (ALT) was measured during ischemia reperfusion. The tissue and cell injury of liver were examined by optical and electron microscopy. Activation of P38MAPK, P44/P42MAPK, and JNK in hepatic tissue was assessed by western blot after 30 min of reperfusion. RESULTS: Serum ALT and cell injury in the liver as examined by optical and electron microscopy was decreased in group L as compared with the group IR. Phosphorylation of P38MAPK, P44/ P42MAPK, and JNK were all increased significantly after 30 min of reperfusion. Phosphorylation of P38MAPK and JNK was reduced by limb ischemia pre-treatment. CONCLUSION Limb ischemia pre-treatment can induce the late phase of preconditioning in rabbit liver through the inhibition of the phosphorylation of P38MAPK and JNK.
Animals ; Extremities ; blood supply ; Ischemic Preconditioning ; methods ; Liver ; blood supply ; MAP Kinase Signaling System ; Male ; Phosphorylation ; Rabbits ; Reperfusion Injury ; prevention & control ; p38 Mitogen-Activated Protein Kinases ; chemistry ; physiology