The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Arteries ; Collagen ; Femoral Artery ; Foreign-Body Reaction ; Free Tissue Flaps ; Humans ; Microsurgery ; Pathology ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Tissue Transplantation ; Transplants ; Veins

PURPOSE: This study was to evaluate the expression pattern of CD 18(leukocyte adhesion glycoprotein) in ischemia-reperfusion injury of TRAM flap of rats. Through this study, we can obtain more information about ischemia-reperfusion injury. We want to develop specific medicine to improve the survival rate of TRAM flap in the future. METHODS: A TRAM flap supplied by a single pedicle superior epigastric artery and vein was elevated on 60 Sprauge-Dawley rats. The rats were divide into 6 groups (each group n=10); Group O: sham, no ischemia-reperfusion injury, Group I: 2 hour reperfusion after 4 hour ischemia, Group II: 4 hour reperfusion after 4 hour ischemia, Group III: 8 hour reperfusion after 4 hour ischemia, Group IV: 12 hour reperfusion after 4 hour ischemia, and Group V: 24 hour reperfusion after 4 hour ischemia. This study consisted of gross examination for flap survival and flow cytometry study of CD18 on neutrophils. RESULTS: The gross measurement of the flap showed different survival rate in group I(71%), II(68%), III(37%), IV(34%) and V(34%). All experimental groups showed an increase in the expression of CD18 compared to group O. The expression of CD18 was rapidly increased in ascending order in group I, II and III. But, the expression of CD18 was maintained in group IV and V. CONCLUSION: The results can be implemented in the study to develop drugs which are capable of reducing ischemia-reperfusion injury in microsurgical breast reconstruction.
Animals ; Epigastric Arteries ; Female ; Flow Cytometry ; Ischemia ; Mammaplasty ; Neutrophils ; Rats* ; Reperfusion ; Reperfusion Injury* ; Survival Rate ; Veins

PURPOSE: Erythropoietin is traditionally known to regulate erythropoiesis, but recently its protective effect against ischemia-reperfusion injury has been studied mainly in cardiovascular and neuronal systems. This study was planned to investigate the effects of recombinant human erythropoietin on ischemia-reperfusion injury in rat TRAM flap model. METHODS: Superiorly based TRAM flap was elevated and ischemic insult was given for four hours. Thirty minutes before reperfusion, single dose recombinant human Erythropoietin(5000IU/kg) was injected via intraperitoneal route in the treatment group. At 24 hours postoperatively, systemic neutrophil count, tissue myeloperoxidase activity, malonyldialdehyde amount, nitric oxide content, tissue water content and histologic finding of inflammation was evaluated. On 10 days postoperatively, flap survival rate, angiogenesis and change in hematocrit level was evaluated. RESULTS: Tissue nitric oxide level was significantly higher and myeloperoxidase activity was significantly lower in the treatment group 24 hours after reperfusion. Tissue water content was significantly lower in the treatment group. Perivascular neutrophil infiltration and intravascular adhesion was marked in the control group. Mean flap survival after ten days was 69% in the treatment group, and 47% in the control group, demonstrating a significant difference. Neovascularization in the treatment group also outnumbered the control group. No significant hematocrit rise was noted ten days after erythropoietin administration. CONCLUSION: Recombinant human Erythropoietin improved flap survival in ischemia-reperfusion injured rat TRAM flaps, at least partially owing to suppressed inflammation, increased nitric oxide, and enhanced angiogenesis.
Animals ; Erythropoiesis ; Erythropoietin* ; Hematocrit ; Humans ; Inflammation ; Malondialdehyde ; Neurons ; Neutrophil Infiltration ; Neutrophils ; Nitric Oxide ; Peroxidase ; Rats* ; Reperfusion ; Reperfusion Injury* ; Survival Rate

Management of chronic osteomyelitis in lower extremity caused by trauma or diabetes has always been difficult. The aim of treatment for these patients are eradication of infection with preservation of the gait function of the leg. Coverage with local and free muscle flaps after complete surgical excision of infected soft tissue and osseous structures is major strategy for treatment of chronic osteomyelitis. There is no doubt that muscle provides good blood flow, thus improves bone healing and increases resistance to bacterial inoculation. But accompanying problems are seen in cases with shallow dead space. In this paper the experience with the use of anterolateral thigh perforator flaps for treatment of osteomyelits is presented. Complete debridement of all non viable, infected and scar tissue and coverage with anterolateral thigh flaps were coupled with through effective antibiotic course in all cases. Follow up periods ranged from 6 to 12 months. All flaps survived completely and osteomyelitis of all cases were subsided. Acceptable gait function was recovered. The Anterolateral thigh perforator flaps can adequate coverage for the treatment of bone infections. It can also be used with combined muscle flaps for reconstruction of large dead space. A dvantages such as acceptable donor site morbidity, short operation time, good sensated reconstruction, and acceptable contours are seen. Reconstruction with anterolateral perforator flaps after complete debridement in the lower limb achieves satisfactory aesthetic and functional results.
Cicatrix ; Debridement ; Follow-Up Studies ; Gait ; Humans ; Leg ; Lower Extremity* ; Osteomyelitis* ; Perforator Flap* ; Thigh* ; Tissue Donors

Sole reconstruction should consider both functional and aesthetic aspects; durable weight bearing surface, adequate contour for normal footwear, protective sensation and solid anchoring to deep tissue to resist shearing. The anterolateral thigh perforator free flap has such favorable characteristics as long pedicle, reliable perforators and minimal donor site morbidity. This flap can be safely thinned to 3-4mm. It can also be elevated with sufficient bulk with muscles like vastus lateralis for complex defect. Between June 2002 and December 2004, 48 cases of sole reconstruction were performed with anterolateral thigh perforator free flaps. Follow up period ranged from 4 to 34 months with a mean of 14.7 months and with exception of one case, all flaps survived. One case of total flap loss was noted due to infection in a patient who was administered lifetime immunosuppressant. Partial necroses developed in three cases but were treated conservatively. Satisfactory aesthetic and functional results were achieved and acceptable gait recovery was noted. Seventy-eight percent of the patients regained protective sensation by 6 months and earlier sensory recovery was noted in sensate flap group. The authors also present a standardized protocol for preoperative patient evaluation and postoperative management and rehabilitation.
Follow-Up Studies ; Free Tissue Flaps* ; Gait ; Humans ; Muscles ; Necrosis ; Perforator Flap ; Quadriceps Muscle ; Rehabilitation ; Sensation ; Thigh* ; Tissue Donors ; Weight-Bearing

No abstract available.
Publishing ; Access to Information ; Social Media ; Congresses as Topic ; Periodicals as Topic ; Biomedical Research ; Journal Impact Factor

The evaluation of pigmentary skin lesions by clinical doctors has been based on subjective and qualitative judgements. Observations have mostly relied on visual inspection, making the effects of treatment difficult to evaluate with any precision. For this reason there is a real need for an objective method to evaluate prognosis after treatment. Recent scientific measurements such as reflectance spectrophotometry and reflectance colorimetry have provided accurate quantitative color information about skin lesions, but these techniques are costly and difficult to apply in the clinical field. The purpose of this study was to develop a simple and cost-effective way of evaluating treatment results. We have developed a software program using the L*a*b* color coordinate system to quantify the effect of treatment and have successfully demonstrated its clinical usefulness. Our method compares the relative color difference between normal skin and skin lesions before and after treatment, instead of measuring the absolute color of skin lesions. The accuracy of our quantitative color analysis was confirmed by the simulated images of hemangioma and ota nevus. Clinical efficacy was also confirmed through a blind test involving 3 clinicians who were asked to grade the treatment effects of 13 cases of hemangioma and 7 cases of ota nevus. These subjective clinical grades correlated well with the treatment results obtained using the proposed color analysis system (Correlation coefficient = 0.84).
Color* ; Female ; Hemangioma/therapy ; Hemangioma/pathology ; Human ; Nevus of Ota/therapy ; Nevus of Ota/pathology ; Outcome Assessment (Health Care)/methods* ; Pigmentation Disorders/therapy* ; Pigmentation Disorders/pathology* ; Skin Neoplasms/therapy ; Skin Neoplasms/pathology ; Skin Pigmentation* ; Software*

The clinical significance of diabetes is increasing with a growing aged population and changes in lifestyle. Among all complications of diabetes mellitus, diabetic ulcers are the most severe and expensive. The lifetime incidence of diabetic foot ulceration is as high as 25%. Ulcers frequently become infected and are associated with the risk of limb amputation and increased mortality and healthcare costs. A specialized multidisciplinary team approach is needed to care for patients with ulceration. Comorbidities such as poor limb circulation and the loss of protective sensation due to diabetic vasculopathy and neuropathy should be treated concurrently to promote wound healing. In cases of ischemia, transluminal angioplasty or bypass surgery may enhance circulation, allowing ulcer healing or reconstructive surgery. With an integrated team approach, the major focus of ulcer treatment has changed from amputation to limb salvage. Appropriate follow-up, including the minimization of risk factors and education on foot care in daily living, is essential to prevent re-ulceration.
Amputation ; Angioplasty ; Comorbidity ; Diabetes Complications ; Diabetic Foot* ; Education ; Extremities ; Follow-Up Studies ; Foot ; Foot Ulcer ; Health Care Costs ; Humans ; Incidence ; Ischemia ; Life Style ; Limb Salvage ; Mortality ; Risk Factors ; Sensation ; Ulcer* ; Wound Healing