Skin Flap Viability Research Articles

Functional genetic variant in the GABRA6 gene interacts with environmental stress to increase the risk of multiple suicide risk-related phenotypes

To date, the surgical delay of skin flaps is the most common and reliable method that increases skin flap survival. In this study, we aimed to increase skin flap viability using preconditioning by microneedling. Seventy-two Sprague Dawley rats were randomly divided into control, surgical flap delay (SFD), and four microneedling groups (7 or 14 days of preconditioning with 0.5 mm or 1 mm needles). Modified McFarlane flaps were raised on the back of rats. In Group I, a caudal pedicled skin flap was raised and the flap survival rate was assessed on postoperative day 14. In the SFD group, a bipedicled flap was created and after 14 days of surgical delay, all skin flaps were raised. In the microneedling groups, 0.5 mm or 1 mm needles were used for 7 or 14 days. The flap survival rates of all microneedling and SFD groups were significantly higher than the control group. The plasma levels of vascular endothelial growth factor (VEGF) did not significantly differ between groups, but the VEGF level of skin samples in the SFD group was higher than the control group. The vessel counts of all microneedling and SFD groups were statistically higher than the control group in all skin samples taken before raising the flaps, but skin samples taken 14 days after raising the skin flap did not show any difference between groups. We showed that preconditioning by microneedling can be used to improve the viability of critical ischemic skin flaps at a level similar to surgical delay.

The Effect of Topical Vitamin A and E on Ischemic Random Skin Flap Survival.

BACKGROUNDIschemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the efficacy of topical vitamins A and E on improving flap survival. METHODSTwenty-four white-albino male rats were randomly divided into two groups of treatment and control. Standard rectangular, distally based dorsal random pattern skin flap was elevated. Intra-peritoneal cephazoline was administered to prevent any unexpected infection. No pharmaceutical agent was administered for the control group, but pure vaseline ointment. In treatment group, vaseline plus vitamins A and E were administrated daily after surgery for 10 days. The rats were evaluated on the 10th day after surgery for viable and necrotic portions of the flaps. RESULTSThe mean values of necrosis in the flaps were 625±189.56 and 920.00±247.31 in the treatment and control groups, respectively. Vaseline plus vitamins increased flap survival significantly.CONCLUSIONTopical vitamins A and E may be effective pharmaceutical agents to increase viability of random skin flaps in rats. They can be added to vasoactive topical agents to reach better results.

Amlodipine improves skin flap viability in rats exposed to nicotine

Background: A recent series of experimental and clinical studies have demonstrated the negative effects of nicotine such as ischemia and necrosis of skin flaps. In order to overcome the negative effects of nicotine numerous studies have been conducted with various agents and methods. In this study, we investigated the effects of amlodipine (AML) on flap survival in nicotinized rats. Materials and Methods: Thirty Sprague Dawley rats were randomly divided into three groups: Group A nicotine; Group B nicotine + AML; Group C control group. The rats in Group A and B have received nicotine for 4 weeks before the surgical intervention. At the end of the 4th week, MacFarlane flaps were elevated and adapted back by suturing in all groups. In Group B, AML has been administered to the rats after the surgery and continued for 10 days. All the flaps were visualized with fluorescein angiography and underwent histopathological assessment. The necrotic areas of the flaps were measured as well. Results: The necrosis rate in Group A was found to be significantly higher compared to Group B (P

Valproic acid enhances the viability of random pattern skin flaps: involvement of enhancing angiogenesis and inhibiting oxidative stress and apoptosis.

BackgroundRandom skin flaps are commonly applied during plastic surgery, but distal flap necrosis limits their clinical applications. Valproic acid (VPA), a histone deacetylase inhibitor and a traditional antiepileptic agent, may promote flap survival.Materials and methodsSprague–Dawley rats were randomly divided into VPA-treated and control groups. All rats received VPA or saline by intraperitoneal injections once daily for 7 days after the modified McFarlane flap model was established. On postoperative day 7, flap survival, laser Doppler blood flow, and water content were examined for flap viability, hematoxylin and eosin staining (H&E), immunohistochemistry (IHC), and Western blot analysis, and the status of angiogenesis, apoptosis, and oxidative stress were detected in the ischemic flaps.ResultsVPA increased the survival area, blood flow, and number of microvessels in skin flaps on postoperative day 7 and reduced edema. VPA promoted angiogenesis by enhancing vascular endothelial growth factor (VEGF) mRNA transcription and upregulating VEGF and cadherin 5 expression, inhibited apoptosis via reduction of caspase 3 cleavage, and relieved oxidative stress by increasing superoxide dismutase (SOD) and glutathione (GSH) levels and reducing the malondialdehyde (MDA) level.ConclusionVPA promoted random skin flap survival by enhancing angiogenesis and inhibiting oxidative stress and apoptosis.

Effect of botulinum toxin type A injection in the viability of dorsal flap in rats

Purpose: Botulinum toxin A (BoNTA) increased the viability of skin flap in healthy rats. Most of the studies injected this substance some days (7-15) before the flap surgery. This treatment is used only for elective surgery, there was no data about the efficacy of BontA when injected in the surgical period. This study aimed to analyze the effect of BontA on the viability of Random flap in a intra surgical injection. Methods: Twenty male Wistar rats (250–300 g) were randomly divided into four groups: saline injection 15 days prior the surgery (G1), BoNTA injection 15 days prior the surgery (G2), saline injection intraoperative period (G3), BoNTA injection intraoperative (G4). A dorsal cutaneous flap (3×10cm) was performed. Survival area and total area of the flaps were measured. Lumen diameter, external arterial diameter and lumen/wall thickness ratio were recorded. Results: Viable area increased in Bonta 15days group when compared to saline-15days (1080.7 ± 307.5 mm2 vs. 1594.5 ± 419.7mm2, p= 0.01) and in the Bonta –intraoperative injection when compared to saline intraoperative injection (1133.3 ± 462.0 mm2 vs. 1389.9 ± 320.4 mm2, p=0.014). The ratio viable area/total area showed similar results (G1 versus G2, 0.43 vs. 0.74; p<0.001, respectively) and G3 versus G4 (0.44 vs. 0.61 p= 0,04). We did not find any difference in the microscopic analysis (lumen diameter, external arterial diameter and lumen/wall thickness ratio). Conclusion: BoNTA injected fifteen days before the surgery increased skin flap viability. However, BontA injected intraoperatory time did not increased the flap viability.

Effects of curculigoside A on random skin flap survival in rats

Necrosis in distal areas of random skin flaps remains a challenging issue. Curculigoside A (CA), one of the main bioactive phenolic compounds, has been reported to induce angiogenesis in vitro by increasing proliferation, tube formation, and migration. In addition, CA was shown to increase vascular endothelial growth factor (VEGF) expression. In this study, we investigated the potential use of CA as a novel candidate to enhance the viability of the ischemic skin flap. A modified McFarlane flap was used as a surgical model in Sprague-Dawley rats. Three groups of rats were treated as follows: the control group received 0.9% saline orally, while rats in the two treatment groups were administered 10 mg/kg or 20 mg/kg CA orally for 7 days, respectively. On day7, the mice were killed, and tissue samples were collected for hematoxylin and eosin staining and immunohistochemical examination, while laser Doppler imaging and oxide-gelatin angiography were performed to assess angiogenesis. Kits for the analysis of superoxide dismutase (SOD) and malondialdehyde (MDA) were used to verify the oxidative stress level. Treating animals with CA significantly increased the surviving portion of the flaps. VEGF and SOD expression and microvessel development were markedly increased, and the MDA level was reduced, in the CA treatment groups. Histological studies demonstrated that CA promoted angiogenesis and attenuated inflammatory cell numbers. These findings indicated that CA increases random skin flap survival.

Genistein Improves Skin Flap Viability in Rats: A Preliminary In Vivo and In Vitro Investigation.

Selective estrogen receptor modulators (SERMs) have been developed to achieve beneficial effects of estrogens while minimizing their side effects. In this context, we decided to evaluate the protective effect of genistein, a natural SERM, on skin flap viability in rats and in a series of in vitro experiments on endothelial cells (migration, proliferation, antioxidant properties, and gene expression profiling following genistein treatment). Our results showed that administration of genistein increased skin flap viability, but importantly, the difference is only significant when treatment is started 3 days prior the flap surgery. Based on our in vitro experiments, it may be hypothesized that the underlying mechanism may rather by mediated by increasing SOD activity and Bcl-2 expression. The gene expression profiling further revealed 9 up-regulated genes (angiogenesis/inflammation promoting: CTGF, CXCL5, IL-6, ITGB3, MMP-14, and VEGF-A; angiogenesis inhibiting: COL18A1, TIMP-2, and TIMP-3). In conclusion, we observed a protective effect of genistein on skin flap viability which could be potentially applied in plastic surgery to women undergoing a reconstructive and/or plastic intervention. Nevertheless, further research is needed to explain the exact underlying mechanism and to find the optimal treatment protocol.

Effects of the traditional Chinese medicine baicalein on the viability of random pattern skin flaps in rats.

BackgroundRandom skin flaps are routinely placed during plastic and reconstructive surgery, but the distal areas often develop ischemia and necrosis. Baicalein, a major flavonoid extracted from the traditional Chinese herbal medicine huangqin, Scutellaria baicalensis Georgi, may improve flap viability.Materials and methodsRats were randomly divided into baicalein and control groups and they underwent placement of modified McFarlane flaps after intraperitoneal administration of baicalein or vehicle. Flap survival and water content were measured 7 days later, as were angiogenesis, apoptosis, and oxidative stress in ischemic flaps.ResultsBaicalein promoted flap survival, reduced edema, increased mean vessel density, and enhanced vascular endothelial growth factor production at both the translational and transcriptional levels. Baicalein reduced caspase 3 cleavage, increased superoxidase dismutase and glutathione levels, and decreased the malondialdehyde level.ConclusionBaicalein promoted flap viability by stimulating angiogenesis and inhibiting apoptosis and oxidation.

All-trans retinoic acid improves the viability of ischemic skin flaps in diabetic rat models

AimsEndothelial progenitor cells (EPCs) play a critical role in neovascularization, which enhances proliferation under all-trans retinoic acid (ATRA) treatment. However, the effects of ATRA on the skin flap survival in diabetic flap ischemia remains unknown. MethodsIschemic random skin flaps were made in 40 diabetic Sprague-Dawley rats with 20 normal rats used as control in this study. At 7 days postoperatively, the surviving area of each skin flap was measured. Immunofluorescence staining was used to analyze capillary density and EPCs recruited to the flaps. The expression of ANG2 and VEGF was determined by Western blotting. Circulating EPC number was determined by flow cytometry. In vitro tube formation experiment was used to analyze the function of EPCs. ResultsThe flap survival rate and capillary density of ATRA-treated flap were significantly increased. Fluorescence-activated cell sorting (FACS) analysis demonstrated a marked increase in systemic CD34+/Flk-1+ EPCs in ATRA-treated rat. The expression of ANG2 and VEGF was increased in diabetic flap tissues under ATRA administration. Furthermore, ATRA administration restored the impaired function of diabetic EPCs in tube formation. ConclusionATRA could notably exert preventive effects against skin flap necrosis and promote neovascularization in diabetic rats, which may partially through elevating the expression of ANG2 and VEGF, and augmenting EPC mobilization.

Effects of Morroniside on the Viability of Random Skin Flaps in Rats

ABSTRACTObjective: The purpose of our experiment was to determine whether morroniside can improve the survival of ischemic skin flaps in rats. Methodology: A total of 40 male Sprague-Dawley rats were randomly divided into two groups (control group and treatment group). Modified McFarlane flaps were performed (causally based, 9 cm × 3 cm). The percentage of survival of each flap was calculated. Flap blood flows were measured by Laser-Doppler flowmeter. Flap vasculature was assessed by angiography after Lead oxide-gelatin injection. Vascular endothelial growth factor (VEGF) was evaluated by immunochemistry. Superoxide Dismutase (SOD) level and malondiadehyde (MDA) content were determined using assay kits. Results: At the seventh postoperative day, the morroniside-treated rats showed a higher percentage of flap survival than the control rats. Flap perfusion and the level of vascular endothelial growth factor were significantly elevated in the morroniside-treated group. In the treatment group, the distal section of the flap was nearly saturated with contrast agent, while in the control group, the contrast agent perfused only half of the flap. In the treatment group, morroniside administration significantly increased SOD level and reduced MDA content. Conclusion: Morroniside can enhance ischemic flap survival.

Effect of Mesenchymal Stem Cells and Chicken Embryo Extract on Flap Viability and Mast Cells in Rat Skin Flaps

ABSTRACTStudy Objective: We investigated the effect of bone marrow mesenchymal stem cells (BMMSCs) and chicken embryo extract (CEE), alone and in combination, on tissue viability of skin flaps, and mast cells (MCs), in an experimental random skin flap (RSF) rat model. Materials and Methods: A 30 mm × 80 mm RSF was made on the dorsum of each of the forty rats, which were then divided into four groups. One group did not receive any treatment and served as the control, the second group received BMMSCs, the third group received CEE + BMMSCs, and the fourth group received CEE. For BMMSC treatment, 6 × 109 BMMSCs were injected into twelve separate injection sites of each flap. Seven days after RSF surgery, the remaining viable part of each flap was measured and examined to determine the number of blood vessels, MCs, and degranulated MCs. Results: The CEE, CEE + BMMSC, and BMMSC groups displayed significantly higher levels of flap viability (ANOVA test: p = 0.000; LSD test for all groups: p = 0.000), and a greater number of vessels (ANOVA test: p = 0.000; LSD test: p = 0.000, 0.002, and 0.012, respectively), compared with the control group. The flap viability was poorer in the BMMSC group than in the CEE and CEE + BMMSC groups. The BMMSC group also had a greater number of degranulated and total MCs, compared with the CEE and CEE + BMMSC groups. Conclusions: We observed biostimulatory effects of BMMSCs, CEE, and CEE + BMMSCs on flap viability and vessel numbers, compared to the control group. MCs produced in response to BMMSC treatment have an inhibitory effect on the RSFs survival in an ischemic tissue model.

Systematic review of methodologies used to assess mastectomy flap viability.

BackgroundAccurate prediction of mastectomy skin flap viability is vital as necrosis causes significant morbidity, potentially compromising results and delaying oncological management. Traditionally assessed by clinical judgement, a more objective evaluation can be provided using intraoperative imaging modalities. This systematic review aimed to compare all intraoperative techniques for assessment of mastectomy flap viability.MethodsA systematic literature review was performed using MEDLINE and Embase databases. Primary outcomes reported included specificity, sensitivity and predictive values of each test, and mean rates of mastectomy flap necrosis and reoperation. Secondary outcomes included cost analysis.ResultsSome 18 studies were included. Designs were prospective cohort study (8), retrospective case series (4), prospective case series (3), retrospective case–control study (1), prospective pilot trial (1) and cost analysis study (1). The studies compared indocyanine green angiography (ICGA) (16 studies) and fluorescein dye angiography (FA) (3 studies) with clinical judgement. Sensitivity and specificity were highest for ICGA (5 studies) ranging from 38 to 100 and 68 to 91 per cent respectively. Both methods overpredicted necrosis. Mean rates of flap necrosis and reoperation decreased with ICGA (7·9 and 5·5 per cent respectively) and FA (3 and 0 per cent) compared with clinical judgement (19·4 and 12·9 per cent). Two studies were designed to define numerical parameters corresponding to perfusion using intraoperative techniques. Two studies performed a cost analysis for ICGA; one claimed a cost benefit and the other advocated its use in high‐risk patients only.ConclusionICGA and FA are potentially useful tools for mastectomy flap assessment. However, the predictive accuracy is subject to the specific settings and model of equipment used. Current recommendations support their use in high‐risk patients.

Indocyanine Green Angiography Use in Breast Reconstruction: A National Analysis of Outcomes and Cost in 110,320 Patients.

Indocyanine green angiography has gained popularity in breast reconstruction for its ability to assess mastectomy skin and tissue flap viability. The authors aim to analyze trends and outcomes associated with indocyanine green angiography use in breast reconstruction. Using 2012 to 2014 data from the Healthcare Cost and Utilization Project National Inpatient Sample, Agency for Healthcare Research and Quality, the authors identified breast reconstructions performed with or without indocyanine green angiography use. Trends over time were assessed using the Cochran-Armitage test. Outcomes were assessed using logistic regression and generalized linear modeling. Over the study period, 110,320 patients underwent breast reconstruction: 107,005 (97.0 percent) without and 3315 (3.0 percent) with indocyanine green angiography use. Usage increased over time: 750 patients (1.9 percent) in 2012, increasing to 1275 patients (3.7 percent) in 2013 (p < 0.001). Smokers (p = 0.018), hypertensive patients (p = 0.046), obese patients (p < 0.001), and those with a higher comorbidity index (p < 0.001) were more likely to undergo indocyanine green angiography. Autologous reconstruction was more frequently combined with its use compared with tissue expander reconstruction (4.5 percent versus 2.1 percent; p < 0.001). There was a significant increase in the odds of débridement associated with its use (OR, 1.404; p < 0.001; 95 percent CI, 1.201 to 1.640). Indocyanine green angiography use in breast reconstruction has increased in recent years and is associated with higher débridement rates. These rates may indicate changing trends for clinicians when deciding whether to débride tissue during breast reconstruction. Therapeutic, III.

Studies on reconstruction of large skin defects following mammary tumor excision in dogs

Aim:The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs.Materials and Methods:Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap.Results:All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image’ J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86.Conclusion:The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb mobility.

Improving Outcomes for Lower Extremity Amputations Using Intraoperative Fluorescent Angiography to Predict Flap Viability.

Nearly 25% of vascular surgery patients operated on for peripheral vascular disease are readmitted within 30 days. Development of adjuncts to minimize wound complications remains an area of great interest. Here, we present our experience with intraoperative fluorescent angiography (IFA) as a tool to predict skin flap viability following lower extremity amputations (LEAs). Experience with IFA using indocyanine green (ICG) dye was reviewed retrospectively at a single institution. Records of patients undergoing LEA with use of IFA by 2 vascular surgeons from 2013 to 2014 were reviewed. Absolute and relative tissue perfusion values were evaluated for sensitivity and specificity in regard to skin flap viability. Thirteen patients with a mean age of 70.5 years (standard deviation [SD] = 12.0, range: 49-93 years) underwent 17 amputations. Indications included rest pain, tissue gangrene, and vascular disease unsuitable for revascularization. Amputation levels included toe (23%), transmetatarsal (18%), below knee (41%), and above knee (18%). Six (35%) amputations required revision with a mean time-to-revision of 26.1 days (SD = 19.9, range: 9-61 days). Of these revisions, 14 (83%) patients proceeded to a proximal-level amputation. Mean follow-up was 235 days (SD = 148, range: 5-448 days), and IFA was used in all cases. Absolute perfusion values (APVs) between 5 and 9 displayed sensitivity and specificity of 50% and 64%, respectively. Additionally, a relative perfusion value (RPV) of ≤31% displayed 100% sensitivity and specificity. Sensitivity and specificity fell to 83% at a relative perfusion of ≤27% and ≤35%, respectively. IFA during LEA is safe and easily performed by the vascular surgeon. The RPVs as a predictor of skin flap viability correlate well with those reported in breast reconstructive surgery. Unfortunately, APVs fail to support any predication for flap failure or success. Patient comorbidities and intraoperative variables such as vasopressor use may contribute to this finding.

Abstract: Does Non-Smoked Nicotine Intake Increase Risk of Post-Operative Complications?

INTRODUCTION: The detrimental health effects of smoking tobacco are well known. Smoking tobacco increases the risks of many post-operative complications, many of which are germane to plastic surgery. The use of non-tobacco nicotine sources has proliferated in the hope that non-smoking delivery methods are safer than smoking; however, there is little data to support or refute this theory.1–4 METHODS: 5 year prospective study, (1/1//2012-12/2016). We informed patients that they should not smoke for 4 weeks before and 6 weeks after their surgery date. Each patient consented to study and allowed their urine to be tested the day of surgery. The patients were encouraged to stop all nicotine use, but if necessary, non-smoked delivery systems (ie transcutaneous patch, chewing gum) would be tolerated. The urine cotinine level was measured in patients undergoing major flap surgery or having general anesthesia. Patients were followed for 6 weeks to monitor for post-operative complications. Post-operative complications included any unplanned outcome requiring medical attention including but not restricted to infections, wound healing problems, unanticipated return to the operating room, etc. We then divided the patients into four groups: non-nicotine users (in the past year), smokers with negative urine test, smokers with positive urine test and non-smoked nicotine users. RESULTS: A total of 340 patients were tested. As expected non-nicotine users (n=264), had the lowest rate of complications at 18% (48). Tobacco smokers that tested positive (21) had the highest complication rate at 28.6% (6), while those testing negative (41) had rate of 19.5% (8) similar to non-smokers. Of note, patients using non-smoked nicotine source (14), developed the highest rate of complications 42.9% (6). Analysis of variance test, p-value of 0.26. CONCLUSION: There is evidence that even when administered through non-smoked methods nicotine does increase the risk of post-operative complications. The increased complication rate in non-smoked nicotine users may be related to higher nicotine blood levels, as it is possible that patches, chewing gum and vaporized usage encourages greater consumption. Given the increasing usage of non-smoked nicotine sources and the perception that the product offers a safe alternative to traditional tobacco use, further studies should be undertaken to better understand clinical implications of usage in aesthetic and plastic surgery. A larger study size could allow for data to reach statistically significant level. Reference Citations: 1. PDE-5 inhibition improves skin flap viability in rats that are exposed to nicotine. Shah A, Pfaff MJ, Assi R, Wu W, Steinbacher DM. Microsurgery. 2014 Jul;34(5):390–7. 2. The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats. Selçuk CT, Kuvat SV, Bozkurt M, Yaşar Z, Gülsün N, Ilgezdi S, Ula M, Ozalp B. J Plast Reconstr Aesthet Surg. 2012 Apr;65(4):489–93. 3. Impact of nicotine replacement therapy on postoperative mortality following coronary artery bypass graft surgery. Paciullo CA, Short MR, Steinke DT, Jennings HR. Ann Pharmacother. 2009 Jul;43(7):1197–202. 4. The association of nicotine replacement therapy with mortality in a medical intensive care unit. Lee AH, Afessa B. Crit Care Med. 2007 Jun;35(6):1517–21

Investigating the Effect of Korean Red Ginseng on the Viability of Random-Pattern Skin Flaps in Rats.

This experimental study investigated the efficacy of Korean Red Ginseng (KRG) extract in reducing the partial losses of random flaps. Forty Wistar Albino rats were randomly distributed into 4 groups as (A) control group, (B) stress group, (C) oral KRG group, and (D) intraperitoneal KRG group. The modified McFarlane flap of 9 × 3 cm with a caudal pedicle was harvested from the back of the rats in all the groups. Korean Red Ginseng was administered to groups C and D at standard doses for 10 days. After 10 days, the flaps were removed in all groups and were examined macroscopically, histopathologically, histochemically, and biochemically. The results were statistically analyzed and compared among the groups. The flap necrosis rates were significantly lower in groups C and D compared with groups A and B (P < 0.05). The vascular density, antioxidant activity, and hypoxia-inducible factor-1α levels were significantly higher in the groups C and D compared with the groups A and B (P < 0.05). Although vascular density, hypoxia-inducible factor-1α, and catalase levels were negatively correlated with the flap necrosis rates, there was a significantly positive correlation between malondialdehyde and necrosis rates. Korean Red Ginseng increases the viability of random pattern skin flaps, resulting in reduced rates of distal necrosis. Korean Red Ginseng has antioxidant activity and increases neovascularization.

Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

Background:Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM) and with a vertical inframammary incision.Methods:A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive. Patient, operative and treatment variables were extracted. All patients with viable mastectomy skin flaps intraoperatively and at least 5 mm of subcutaneous tissue were eligible except for patients who were deemed too slim by the senior surgeon preoperatively and thus at risk of implant visibility or skin rippling.Results:There were 26 patients (bilateral n = 12 and unilateral n = 14) eligible for analysis, with a median long-term follow-up of 51.5 months. The majority of complications were classified as minor affecting 46.2% of the cohort (n = 12). There were 20 episodes of complications overall. The most frequent episodes were contour defects (x = 5), minor seroma (x = 4), and malrotation and minor infection (x = 3). There was 1 episode of capsular contracture.Conclusion:Skin-sparing mastectomy with immediate subcutaneous silicon implant reconstruction with a vertical incision and without the need for mesh or ADM is an acceptable and safe treatment option. Accurate patient selection and skin flap viability is the key to achieving optimal outcomes with this approach.

The Effect of Omeprazole Usage on the Viability of Random Pattern Skin Flaps in Rats

Necrosis of random pattern flaps caused by inadequate blood flow, especially in the distal part of the flap is one of the biggest challenges in reconstructive surgery. Various agents have been used to prevent flap ischemia. In this study, we used omeprazole, which is a potent inhibitor of gastric acidity to increase flap viability. In this study, 35 Wistar-Albino type rats which were divided into 5 equal groups were used. Random-pattern dorsal skin flaps were raised in all groups at seventh day of the study. Group 1 was accepted as control group, and the rats in this group was only given distilled water intraperitoneally for 14 days. Group 2 and group 3 received 10 and 40 mg/kg omeprazole daily for 14 days, respectively. Group 4 and group 5 were given distilled water for the first 7 days and then after the operations they received 10 and 40 mg/kg omeprazole daily for 7 days, respectively. Survival rates of the flaps were examined seventh day after elevation of the flaps by digital imaging and scintigraphy. After assessment of the amount of necrosis, number of vascular structures were counted histopathologically. Percentage of flap necrosis was found to be less in all omeprazole received groups. On digital imaging, percentages of flap necrosis in the study groups were statistically significantly lower than that of the control group (P < 0.001), but there was no significant difference between the study groups (P > 0.05).In the histopathologic specimens, it was detected that the mean number of vessels in proximal (a) and distal (c) portions of the flap in the study groups showed a significant increase when compared with the control group (P < 0.01 for groups 2, 4 and 5, and P < 0.05 for group 3). In conclusion, possible clinical usage of medications increasing gastrin during flap surgeries can be thought as a positive contributor. In this sense, this study showed that parenteral administration of omeprazole in skin flap surgery increases flap viability possibly by increasing gastrin levels.

Abstract 30: Effect of Adipose Stromal Vascular Fraction on Random Pattern Flap Viability in Rats With Diabetes And Chronic Renal Disease: An Experimental Study

Corrected and republished with permission from the European Plastic Surgery Research Council Meeting 2016 supplement to the January 2017 compendium of PRS Global Open. Ozkan B, Çagri Uysal A, Terzi A, Özturan Özer E. Abstract: 11.10 Effect of adipose stromal vascular fraction on random pattern flap viability in rats with diabetes and chronic renal disease: an experimental study. Plast Reconstr Surg Glob Open 2017;5(1S):7. DOI: 10.1097/01.GOX.0000512409.03081.d3 Please refer to Correction Notice on page 127 of this supplement. INTRODUCTION: Diabetes (DM) and chronic renal disease (CRD) are epidemic diseases with increasing prevalence. Wounds due to microangiopathy and macroangiopathy tend to heal slowly which can lead to severe morbidites such as amputations. High flap failure rates reported in the reconstruction of these wounds. Studies have shown increased flap viability by adipose derived stromal vascular fraction (SVF). However; there is no study in the literature about the effect of adipose stromal vascular fraction on skin flap viability in chronic renal disease and diabetes with chronic renal disease. MATERIALS AND METHODS: 48 male Sprague Dawley rats were used. Diabetes was induced by 65mg/kg intraperitoneal streptozocin administiration. Chronic renal disease was induced by 5/6 nephrectomy. Four groups consisting of 12 rats were formed. 2 rats were used for obtaining adipose tissue from the inguinal regions for stromal vascular fraction preparation in each group. Group I (Control group): Two dorsal flaps were elevated, phosphate buffered saline (PBS) were injected to the flaps. Group II (DM), Group III(CRD), Group IV(DM+CRD): After disease induction and period;, two dorsal flaps were elevated, SVF were injected to the left flap, PBS were injected to the right flap. Flaps were harvested for macroscopic and histopathological assessments at postoperative 7th day. Percentage of flap viability measurement and microangiography were performed for macroscopic assessment. Capillary density assessment were evaluated in both hemotoxylin-eosin and CD31 stained specimens for microscopic assessment. Plasma levels of VEGF were studied in all rats at day 1 and day 7. RESULTS: SVF was improved flap viability significantly (p<0,05). New capillary formation found significantly more in SVF groups in capillary density assessment (p<0,05). This result was compatible with the scarcity of the vasculature in microangiography. When blood VEGF levels were compared, increase in day 1 and day 7 were significant according to control group (p<0,05). When groups were compared each other there were not significant difference except Group II(diabetes). CONCLUSIONS: The result of the study has shown that DM and CRD impaired flap viability. Diabetes with chronic renal disease deteriorated the flap viability much more. It has shown that SVF were increased flap viability via neovascularization by endothelial differentiation. Flap viability percentage was found lower in diabetic and uremic groups when compared with healthy control group. Blood VEGF levels were not elevated in uremic groups. This results were indicated that in vivo function of stem cells were possibly impaired by uremia dominantly and diabetes due to microenviromental changings.