Random Skin Research Articles

Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up

BackgroundPatellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon.Case presentationA 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result.Discussion and conclusionsOur technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.

Effects of luteolin on random pattern skin flaps in rats

Luteolin, a natural flavonoid, has anti-inflammatory, antioxidant, and antiapoptotic properties. Studies showed that luteolin protects tissues against ischemia-reperfusion injury on liver, neural tissue, and myocard. This study was designed to evaluate the effects of luteolin on random pattern skin flap in rats. Sixteen rats were randomly divided into two groups (n = 8 each group: luteolin group: Land control group: C). Ten milligram per kilogram of luteolin diluted with saline was given intraperitoneally 30 min before and 12 h after surgery. Tissue samples were taken for biochemical analysis at the first day and at the seventh day for histopathological analysis. Catalase, malondialdehyde (MDA), xanthine oxidase (XO), and nitric oxide (NO) levels were measured with spectrophotometrical method. Edema, inflammatory cell infiltration, necrosis, and fibrosis were evaluated and scored. Flap survival ratios were measured. Statistical analysis was performed by SPSS for Windows 15.0. Tissue catalase levels were found significantly higher and MDA levels significantly lower in luteolin group respectively (L 65.38, C 39.80, p = 0.02; L 3.525, C 6.97, p = 0.01). XO and NO levels were found higher in luteolin group, but this difference was not significant (L 0.089, C 0.078, p = 0.17; L 41.75, C 37, p = 0.79). Edema, inflammatory cell infiltration, and necrosis were scored significantly lower in luteolin group (L +, C +++, p = 0.003; L +, C +++, p = 0.0004; L ±, C +++, p = 0.0021). Fibrosis scores were significantly higher in luteolin group (L +++, C +, p < 0.001). Flap survival was significantly higher in luteolin group (L 37.55, C 49.7, p = 0.02). Luteolin has shown beneficial effects on random pattern skin flap in rats. Additional experiments are warranted to investigate the XO and NO mechanisms during ischemic injury. Level of evidence: Not ratable

Effect of dipyridamole on random pattern skin flap viability in rats

Ischemic necrosis has been most dreaded complication of flap reconstruction. Therefore, researchers have tried to improvise modalities to prevent or treat it since the onset of flap surgery. So far these researches have failed to identify a pharmacological therapy equally effective as surgical delay in augmenting skin flap viability. In the path of search for this substance, dipyridamole attracted our attention as an antiaggregant agent. Put together with pathophysiological mechanisms underlying ischemic flap necrosis, we concluded dipyridamole might have beneficial effect on survival of skin flaps. In this research random pattern dorsal rat skin flap model of McFarlane is used. Subjects are separated in a randomized fashion between two groups. Experiment group is given dipyridamole with a dose of 20 mg/kg twice daily. Control group is given same amount of saline. At seventh day viability of skin flaps is assessed and compared between groups. Also on 7th day, pathologic specimens are obtained and evaluated histopathologically in terms of neutrophil and lymphocyte infiltration, edema and fibrosis. Necrosis percentage in experiment group is found to be significantly lower than that of control group (p < 0.01*). Neutrophil infiltration and edema found to be significantly lower in dipyridamole group (p < 0.05*). No significant difference is observed in lymphocyte infiltration and fibrosis. Dipyridamole is shown in this research to be effective in augmenting viability of random pattern skin flaps in rats. Nevertheless, more extensive researches are needed to fully determine its precise mechanism, side effects and appropriate doses.

Konsantre büyüme faktörünün random patern cilt flep yaşayabilirliği üzerine etkisi: deneysel çalışma

Giriş: Plastik ve rekonstrüktif cerrahide, random patern cilt flepleri çeşitli nedenlerle oluşan doku defektlerinin onarımında sıklıkla kullanılmaktadır. Bu tür fleplerde en sık karşılaşılan sorun yetersiz kan akımına bağlı flep distalinde görülen iskemik nekrozdur. Flep kayıplarını ortadan kaldırmak ve azaltmak için çok sayıda teknik tanımlanmıştır. Bu çalışmadaki amacımız tam kandan elde edilen ve büyüme faktörleri açısından zengin olan konsantre büyüme faktörünün (CGF) daha önce çalışılmamış olan random patern cilt flep yaşayabilirliği üzerine etkisini incelemektir. Gereç ve Yöntem: Çalışmada 50 adet Spraque –Dawley cinsi sıçan kullanıldı. Sıçanların 40 tanesi deney için, 10 tanesi CGF elde etmek için kullanıldı. Sıçanların sırt bölgelerinden kaldırılan 3x9 cm’lik distal bazlı McFarlene fleplerinin altına çalışma grubunda (n:20) CGF matriks yerleştirildi. Kontrol grubunda (n:20) herhangi bir tedavi uygulanmadı. İşlem sonrası 7. günde değerlendirme için fotoğrafik, sintigrafik ve histopatolojik inceleme yapıldı. Bulgular: Alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %53 (47-58) olarak bulundu. CGF uygulanan grupta ise flep viabilite ortanca oranı %58 (55-64) olarak bulundu. CGF grubunda elde edilen yüksek flep yaşayabilirlik oranları istatistiksel olarak anlamlı bulundu (p&amp;lt;0,001). Sintigrafik perfüzyon alan hesaplamaları sonucunda kontrol grubunda flep yaşayabilirlik oranlarının ortanca değerleri %54 (51-60) iken bu değer CGF uygulanan grupta %61 (59-64)’di. Elde edilen artış istatistiksel olarak anlamlı bulundu (p=0,001). Histopatolojik değerlendirme sonucunda çalışma grubunda elde edilen vaskülarite skorlarının ortanca değerlerinin (10,0 (8,25-11,75)) kontrol grubuna (7,5(6,25-9,00)) göre fazla olduğu görüldü ve bu fark istatistiksel olarak anlamlı bulundu (p=0,003). İnflamasyon skorları açısından gruplar arasında anlamlı farklılık saptanmadı (p=0,246). Sonuç: Bu çalışmanın sonuçları lokal olarak flep altına uygulanan konsantre büyüme faktörünün flep yaşayabilirliğini artırdığını ve bu etkinin anjiogenez ile ilişkili olabileceği gösterilmiştir ancak bu konuda ileri çalışmalara ihtiyaç vardır. Flep cerrahisinde, iskemi öngörülen durumlarda büyüme faktörlerinden zengin CGF’in uygulanmasının flep yaşayabilirliği üzerine olumlu etkileri olacaktır.

Transferring the protective effect of remote ischemic preconditioning on skin flap among rats by blood serum

The aim of this study was to show whether the protective effect of remote ischemic preconditioning (RIPC) on flaps can be transferred among different individuals with the transfusion of blood serum. Blood serum was taken from rats without any procedure (Group x), rats 1 hour (Group y) and 24 hours (Group z) after performing RIPC and the remaining rats were divided into six groups. While the random pattern skin flap was performed only in the back region in Group 1, and it was performed 1 hour (Group 2) and 24 hours (Group 3) after induction RIPC. Flap surgery was performed after the intravenous injection of serum obtained from Group x in Group 4, from Group y in Group 5, and from Group z in Group 6. After 7 days, the ratios of viable areas in the flaps of the remaining rats were calculated. When the viable area ratios in the flaps to the whole flap area were calculated, it was found out that the viable area ratios in Group 2 (61.6%), Group 3 (75.6%) and Group 6 (74.2%) were statistically significantly higher compared to Group 1 (51.5%), Group 4 (52.6%) and Group 5 (58.7%), that viable area ratios in Groups 3 and 6 were statistically significantly higher compared to Group 2, and that there was no difference between Groups 3 and 6. This study showed that RIPC forms a protective effect on the flaps and that this effect could be transferred among individuals with blood serum.

Pathology and classification of aggressive mature B-cell lymphomas.

Pathology and classification of aggressive mature B-cell lymphomas.

Reconstruction of skin and soft tissue defects of the outer ear in patients with severe burn injuries: analysis of three different operative techniques

An early soft tissue reconstruction is mandatory after burns of the outer ear to avoid cartilage loss. Although different procedures for covering soft tissue defects of the outer ear have been described in the past, the biomechanical properties and cosmetic outcome of reconstructed burned tissue are yet to be investigated more thoroughly. Using photographs and the Cutometer, a device for measuring biomechanical skin properties such as firmness and elasticity, the 12 ears in six healthy volunteers and the 12 mainly deep partial-thickness injured ears in six patients who suffered burn injuries were examined. Three of the burned ears were covered with temporoparietal fascial flaps with split skin grafts based on the superficial temporal artery, four with retroauricular random pattern flaps, and five with full thickness skin graft. The median values of the firmness and elasticity of skin were approximately equal in the control group compared to the random pattern flap group. The median values of firmness and elasticity differ between the control group and the temporoparietal fascial flap and skin graft group (p = 0.05). Cosmetic outcome in terms of anatomical structures revealed full thickness grafts as the superior method. Considering burn depth, the results of cosmetic outcome support the clinical principle of the reconstructive ladder, suggesting full thickness skin grafts as first choice. If high biomechanical skin quality is necessary, random pattern skin flaps from the lateral head region were the favorable procedure for burn reconstructions in the outer ear. Level of Evidence: Level III, therapeutic study.

Local random pattern skin flaps for repair of scalp defects: 22 case reports

Local random pattern skin flaps for repair of scalp defects: 22 case reports

Effect of hirudin on promotion of blood supply and angiogenesis in rat ischemic skin flap

Objective To study the effect of hirudin on perfusion and angiogenesis in distal ischemic skin flap. Methods The 35 SD rats, two random dorsal skin flaps were made on individual SD rat and assigned randomly into hirudin group and control group. Hirudin group was injected with 0.5 U hirudin and control group injected with the same amount of saline. The distal flap tissue perfusion, microvessel density (MVD) of flap biopsies and expression of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) were detected by a full-field laser perfusion imager, immunohistochemistry and Western blot, respectively. The flap survival areas at day 6 were also measured. Results Compared with control group, hirudin group resulted in enhanced distal flap perfusion on day 1 (P<0.05), higher MVD at day 4 (P<0.05) and significant upregulation of flap VEGF levels during days 1-6 (P<0.05). The expression of TSP-1 in hirudin group was significantly lower at days 1-4 (P<0.05) than that of control group. Larger mean flap survival area was observed in the hirudin group (P<0.05). Conclusions Hirudin improves ischemic skin tissue survival through enhancing the recovery of perfusion, regulating angiogenesis associated factors, and facilitating microvessel formation in ischemic flap. Key words: Hirudin; Random pattern skin flap; Vascular endothelial growth factor; Thrombospondin-1

Efficacy of Liposuction as a Delay Method for Improving Flap Survival.

Flaps are often used in repairing tissue defects and partial or full flap loss is still an important morbidity cause. Several techniques have been tried to increase flap circulation but none of these could replace the delay technique. Our goal in this study is to show the efficacy of liposuction in delay of dorsal rat cutaneous flaps and improvement in flap survival. Twenty-four Wistar rats were used. The rats in group 1 received 9×3-sized caudally-based random pattern skin flaps. In group 2, liposuction was done under the tissue island spotted as the flap and after 14days, standard flap surgery was done. In group 3, surgical delay was done and after 14days, standard flap surgery was done. In group 4, liposuction was done under the tissue island spotted as the flap and standard flap surgery was done right after the liposuction. The rate of necrotic tissue in group 3 (surgical delay; mean % 13.7) was less than the rate in group 2 (liposuction delay; mean % 15.1), although the difference was not statistically significant. The necrosis rates in group 3 (surgical delay) and group 2 (liposuction delay) were less than the rates in both group 1 (only flap; mean % 41.5) and group 4 (liposuction flap; mean % 40.0) and this difference was statistically significant (p<0.0001). Liposuction can be an alternative to surgical delay as a less invasive method in the clinic. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

RTFPI reduces ischemic necrosis in random pattern skin flap avulsion injuries rat model

Objective To determine whether rTFPI could inhibit vascular thrombosis and salvage random pattern skin flaps following AIRC in rat models. Methods From April, 2013 to June, 2015, 30 adult male Sprague-Dawley rats were randomized into 3 groups; a control group, an avulsion injury with roll compaction (AIRC) group, and an AIRC plus rTFPI therapy group. An 8.0 cm × 2.5 cm random flap was raised on the dorsum of each rat. The AIRC and AIRC plus rTFPI flaps were then altered with a device designed to simulate avulsion injury with roll compaction. After flap closure primarily, treatment was initiated immediately and continued for 3 days. Phosphate buffered saline was used in the control group and the AIRC group, while the AIRC plus rTFPI group received the recombinant Tissue Factor Pathway Inhibitor. Laser Doppler flowmetry and infra-red thermalgraphy were used on postoperative day three to assess microcirculatory blood flow and viability of the avulsed flaps. At postoperative day seven, final flap survival was determined. Using SPSS19.0 statistical analysis. Results The flap survival in AIRC group was only (32.7 ± 5.2)% versus (62.5 ± 6.5)% in control group, but the flap survival significantly increased (51.6 ± 8.2)% after topical injecting rTFPI in experimental group. Statistically significant differences exist (P < 0.05) between every two groups. The detection results of Laser-Doppler flowmetry and infra-red thermography showed that perfusion arrived the centre of the flaps in experimental group, while perfusion only arrived the proximal part of the flaps in the AIRC control group. Conclusion rTFPI therapy is effective in reducing ischemic necrosis of random pattern flaps following avulsion injury in the rat model. It suggests that rTFPI therapy may play an important role in clinical salvage of the failing avulsion injuries with roll compaction. Key words: Skin flap avulsion injuries; Recombinant tissue factor pathway inhibitor; Extrinsic coagulation pathway; Rat

Effect of Korean red ginseng extract on flap survival and angiogenesis in rat model

Background Despite its poor predictability of survival, random pattern skin flap has been the most commonly used reconstructive method until recently. To overcome its shortcomings, there have been numerous pharmacologic trials and research to enhance survivability. The authors tried Korean red ginseng extract (KRGE), a well-known herb remedy for its outstanding angiogenecity and vasculogenic properties.

Effects of ozone pretreatment on viability of random pattern skin flaps in rats

Background: Medical ozone is a chemical agent that consists of three oxygen atoms and has antioxidant, angiogenic and vasodilator effects. This study evaluated the effects of medical ozone pre-treatment on flap survival. Materials and methods: Rats were divided into four groups of 10 rats each and a 9 × 3 cm McFarlane flap was used. Sham group: Neither surgical nor ozone pretreatment was used. Control group: No pretreatment was used after surgery. Preoperative ozone group: Preoperative 1 mg/kg ozone was given intraperitoneally for 7 days. No pretreatment was used after surgery. Postoperative ozone Group: Postoperative 1 mg/kg ozone was given intraperitoneally for 7 days. After postoperative 1 week, all groups were evaluated by surface area measurement, histopathology and electron microscopy. Results: With the experimental McFarlane flap model, the experimental groups had better surface area measurements, along with histopathological and electron microscopic results when compared with the control group. Conclusion: Medical ozone had positive effects on flap survival due to its antioxidant, angiogenic and vasodilator qualities.

The Effect of Local Application of Natural Hirudin on Random Pattern Skin Flap Microcirculation in a Porcine Model

The aim of this study was to investigate the effect of local administration of hirudin in improving random pattern skin flap microcirculation in a porcine model. Five Chinese minipigs were used and six dorsal random pattern skin flaps were elevated in each animal (4 × 14 cm). All flaps (n = 30) were assigned to experimental (n = 10), control (n = 10), and sham (n = 10) groups. Flap edema measurement showed that edema in experimental flaps was more severe (P < 0.05) than either control or sham flaps. Local blood flow detection showed an increased image signal of blood flow in experimental flaps instead of an obvious avascular area in control and sham flaps. The survival area was significantly greater in experimental group (67.6 ± 2.1 %) as compared to control (45.2 ± 1.4 %) or sham (48.3 ± 1.1 %) group (P < 0.05). Our data showed that local administration of hirudin can significantly improve random pattern skin flap microcirculation in over dimensioned random pattern skin flaps in a porcine model.

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

Effect of deferasirox on DLL4 expression and angiogenesis in a slender narrow pedicle and random flap in rats

Objective To investigate the effect of deferasirox on DLL4 expression and angiogenesis in a narrow pedicle and random flap in rats.Methods Twenty SD rats were randomly divided into the deferagirox group and control group.Rats were subjected to deferagirox of 100 mg · kg-1 · d-1 inthe experimental groups,respectively and the same dose saline in the control group for 1 week. In each group,flap were created in the bilateral back of each rats.Ratio of length to width of tissue in the pedicle portion and the flap portion was 1 cm × 1 cm and 3 cm × 3 cm,respectively.The tissue samples were taken from the pedicle and the middle portions of the flap.The DLL4 and CD105 expression was also detected with immunohistochemistry (SABC).Results Compared with control group,whatever in the pedicle portion or the middle portion,there was a significant increase of microvessels marked by CD105 and a significant decrease of flap microvessels stained by DLL4 in the deferagirox group.In both groups,compared with the pedicle portion,there was a significant increase of microvessels marked by CD105 and DLL4 in the the middle portion.Conclusions Deferasirox can in crease the CD105 expression and angiogenesis of the slender narrow pedicle random flap.This process might be related to the inhibition of DLL4 protein expression,which is significant in the notch signaling pathway. Key words: Delta-like 4; CD105; Deferasirox; Random pattern skin flap; Rats

Application of slender narrow subcutaneous fascia pedicle random flap in repair of the cavity of concha wound

Objective To introduce the application of slender narrow subcutaneous fascia pedicle flap in repairing the cavity of conchs wound in microtia plasty,and to investigate its survival mechanism.Methods The all 6 congenital microtia cases were repaired with the concha compound flap up rotation.The all microtia concha wounds were repaired with the slender narrow pedicle.The lateral maxillocevicai fasciotaneous flap with its slender subcutaneous fascia pedlcle located in front of auricle.The size of the flaps ranged from 3.0 cm × 3.0 cm to 4.0 cm × 4.5 cm,The width and length of the pedicle ranged 1.0-1.5 cm and 3.5-4.5 cm.Results 6 cases of the slender narrow subcutaneous fascia pedlcle flaps all survived,with primary wound healing and ideal appearance.Conclusions This slender narrow subcutaneous fascia pedlcle flap does not contain any major blood vessel,which is dissected easily in the operation.Due to its slender narrow pedicle,the flap rotation is also easy and its coverage area is large,without cat ears.The postoperative appearance (color,lexture,cosmetic aspect)is satisfactory.The slender narrow flap is an extraordinary new design and is ideal for the cavity of concha wound repair in the microtia plasty. Key words: Fascio-cutaneous flap; Random pattern skin flap; Microtia; Cavity of concha; Repair

Effects of metallothionein on flap necrosis and apoptosis

Objective To investigate whether metallothionein （MT） influences necrosis and expression of bcl-2 and bax in random pattern skin flaps of rats. Methods After flap operation, the rats in MT group were injected with MT, and those in control group received an injection of drug-free saline. Survival rate of the flaps was measured and the changes in the tissue were observed under the light microscopy. By using Doppler, the blood flow of flap was measured. The expression of bcl-2 and bax was detected. Results The survival area in MT group （ 69. 88 ± 3.12） % was significantly greater （ P 〈 0. 01 ） than that in control group （ 60. 65 - 2. 98 ） %. There were more inflammatory cells in control group than in MT group. LDF in MT group was significiently higher than that in control group （P 〈0. 01） 1st h, 2nd h, 3rd h, 6th h, 1st day, 3rd day, 6th and 7th day postoperatiou and at the 10th day postoperation （P 〈0. 05）. At the 3rd day postoperation, the expression of bcl-2 in MT group （2. 98 ± 0. 23 ） was significantly higher than that in control group （ 1.24 ± 0. 11 ） （ P 〈 0. 01 ）. The expression of bax in MT group （0. 09 ± 0. 02） was significantly lower than that in control group （ 0. 23 ± 0. 09 ） （ P 〈 0. 01 ）. Conclusion MT can affect the expression of bcl-2 and bax and significantly promote survival of skin flap. Key words: Surgical flap; Metallothionein; Apoptosis

The effects of basic fibroblast growth factor-fibrin glue on the survival of the random pattern skin flap

Objective To explore the effects of basic fibroblast growth factor-fibrin glue (bFGF-FG) on the survival of early pedicle division of random pattern skin flap. Methods bFGF-FG were prepared and sprayed under the random pattern skin flaps.The pedicles were divided 4 days later. 10 days later,flap survivals and the microvascular densities of each group were determined.Results The flap survival rate were (75.6 ± 8.9) %,(68.3 ± 9.3) % and (51.4 ± 11.2) % respectively, and the microvascular densities were (24.15 ± 6.42 ) mm2, ( 20.6 ± 4.56 ) mm2 and ( 15.95 ± 3.18 ) mm2 respectively .There was significant difference statistically.Conclusions The bFGF-FG can increase the survival of early pedicle division of random flap more effectively. Key words: Basic fibroblast growth factor; Fibrin glue; Random pattern skin flap

Dipyrone Increases the Blood Flow of Arterial Dorsal Skin Flaps

Findings have shown that dipyrone has a beneficial effect on skin flap survival. A pharmacologic explanation for this effect points to its vascular smooth muscle-relaxing effect. This study evaluated the effect of dipyrone on blood flow and thus survival of rat random dorsal skin flaps. For this study, 27 male Wistar albino rats were randomly assigned to control (treated with sterile saline) and treatment (treated with dipyrone 100 mg/kg) groups. A random dorsal skin flap measuring 4 x 10 cm was raised in each animal. The edges of the flap were sutured back into their original place. Dipyrone treatment continued at 100 mg/kg per day during the 7-day observation period. Blood flow was recorded by laser Doppler preoperatively (baseline), immediately after the flap was sutured back to its original position (acute), and on postoperative day 7. The degree of necrosis was evaluated by the grid method on day 7. Mean percentage necrosis and minimum laser Doppler readings were compared between the two groups. A significant increase in blood flow was observed in the dipyrone group at the acute phase but not on postoperative day 7. The percentage of the necrotic area was lower in the treatment group. However, it did not reach the significance level (p = 0.09). Dipyrone significantly increases [corrected] skin blood flow at the acute phase of flap elevation although the necrotic area does not reach the significance level.