Superficial Epigastric Artery Research Articles

Inhibition and potentiation of the mechanoreflex following pharmacological modulation of TRPC6 in male rats

We determined the role played by the transient receptor potential canonical 6 (TRPC6) in evoking the mechanical component of the exercise pressor reflex in male decerebrated Sprague-Dawley rats. Quadruple-labelled immunohistochemistry were used in dorsal root ganglion cells to identify the cells that innervate the triceps surae muscles (DiI), the cells that express TRPC6 and the cells that are (Nf200) or are not myelinated (peripherin) (n=4). In addition, static contraction of triceps surae muscles was evoked by electrically stimulating the left tibial nerve before and after injecting into the superficial epigastric artery the TRPC6 antagonists, BI-749327 (n = 11; 12μg.kg−1) or SAR7334 (n = 11; 7μg.kg−1), or the TRPC6 positive modulator, C20 (n = 11; 18μg.kg−1). Similar experiments were conducted while the triceps surae muscles were passively stretched (n = 8 to 12), a maneuver that isolates the mechanical component of the reflex. Blood pressure, tension, renal sympathetic nerve activity (RSNA) and blood flow were recorded throughout the experiments. The neurons innervating the triceps-surae muscles were positive to TRPC6 antigen and co-expressed the neurofilament 200kDa. These cells were not positive for peripherin. While the TRPC6 blockers decreased the pressor response to static contraction (-32 to -42%; P < 0.05) and passive stretch (-35 to 52%; P < 0.05), the positive modulator increased both of these responses (55 to 65%; P < 0.05). In addition, BI-749327 decreased the peak and integrated RSNA responses to both static contraction (-39 to -43%; P < 0.05) and passive stretch (-56 to -62%; P < 0.05) whereas C20 increased these responses to stretch only (55 to 235%; P < 0.05). All of these results were not replicated when the drugs were injected intravenously or when the vehicle of the drug was injected into the superficial epigastric artery. Collectively, our results showed that TRPC6 play a key role in evoking the mechanical component of the exercise pressor reflex in male rats. Supported by NIH grants HL 161160, HL 156594 and HL 156513. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Dual intravascular stent flipping technique for microvascular anastomosis

The anastomosis of vessels <0.5mm in diameter is challenging. We developed a supermicrosurgical anastomosis technique, the dual intravascular stent flipping technique with a double or single clip (dual flipping technique, double-clip technique, and single-clip technique). In the dual flipping technique, we used a 7-0 nylon intravascular stent and clipped the vessel along with the nylon. The double-clip technique was performed in 10 rats with 20 saphenous and 15 superficial inferior epigastric arteries. Immediate and 1-week patency rates were assessed. Subsequently, we examined ten epigastric arteries in five rats with the single-clip technique. The clinical application was performed in six cases involving finger/fingertip amputations, two cases involving radial artery superficial palmar branch flap, and one case involving superficial circumflex iliac artery perforator flap. Using the double-clip technique, the immediate patency rate was 90% and 93% in the saphenous and superficial epigastric arteries, respectively, whereas the 1-week patency rate was 81%. With the single-clip technique, the immediate patency rate was 100%. The replantation and flaps were successful. The advantages of the dual flipping technique included easy insertion, rare slipping-out possibility, and spontaneous vessel dilation by the flipped nylon. Additionally, the posterior vessel wall could be sutured more easily than could the anterior wall. By using the elasticity of the thread to invert the blood vessel, the posterior wall can be sutured without the double clip. When forceps tip insertion into the lumen is difficult, the dual flipping technique enables a relatively easy anastomosis if the 7-0 nylon is inserted into the vessel lumen.

Application of folded transverse superficial epigastric artery perforator flap for large penetrating defect after buccal carcinoma resection

To explore the effectiveness of folded transverse superficial epigastric artery perforator flap in repairing the large penetrating defect after buccal carcinoma resection. Between January 2019 and June 2021, 12 patients with buccal squamous cell carcinoma were treated. There were 6 males and 6 females with an average of 66.9 years (range, 53-79 years). The pathological stage was T3a-T4b, and the preoperative mouth opening was (3.08±0.46) cm. The disease duration ranged from 6 to 24 months, with an average of 15 months. After buccal carcinoma radical resection and neck lymph node dissection, the penetrating defects in size of 8 cm×6 cm to 16 cm×8 cm and in depth of 0.5-1.5 cm were remained. The transverse superficial epigastric artery perforator flap in size of 8 cm×6 cm to 14 cm×8 cm were harvested and folded to repair the penetrating defects. The donor site was sutured directly. All 12 skin flaps survived after operation, and the wounds healed by first intention. No internal or external fistula complications occurred. All incisions at the recipient site healed by first intention. All patients were followed up 12-18 months (mean, 14 months). There was no obvious abnormality in the color and texture of the flap, the oral and facial appearances were symmetrical, and there was no obvious swelling in the cheek. At last follow-up, the patient's mouth opening was (2.89±0.33) cm, which was not significantly different from that before operation ( t=1.879, P=0.087). The subjective satisfaction scores of 12 patients were 6-8 points, with an average of 7.3 points. Significant scars remained at the donor site but concealed in location. The folded transverse superficial epigastric artery perforator flap can be used as a surgical method for repairing large penetrating defects after the buccal carcinoma resection, with a good recovery of facial appearance and oral function.

Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach.

We aimed to compare the feasibility, effectiveness, and safety of transabdominal ultrasound-guided oocyte retrieval (TUGOR) using a vaginal probe and traditional vaginal approach in virgin patients undergoing oocyte cryopreservation. A total of 116 virgin patients who underwent transabdominal ultrasound-guided oocyte retrieval using a vaginal ultrasound probe and 33 patients matched for BMI, antral follicle count, age, day 3 FSH, estradiol, and AMH who underwent vaginal approach were enrolled. Mean number of total oocytes collected, mean number of cryopreserved MII oocytes, duration of the procedure, duration of stimulation, mean gonadotropin consumption, mature oocyte ratio, and a modified follicle-oocyte index were compared between the groups. No statistical difference was found between the groups in mean number of follicles > 12mm (4.62 ± 4.54 vs. 5.44 ± 4.52), mean number of oocytes collected (4.44 ± 4.14 vs. 5.33 ± 4.52), mean number of cryopreserved MII oocytes (4.01 ± 3.67 vs. 4.53 ± 4.13), mean duration of the procedure (12.4 ± 1.2 vs. 13.4 ± 1.6min), mean days of stimulation (8.05 ± 1.91 vs. 8.35 ± 1.72days), mean gonadotropin consumption (1507.9 ± 475.3 vs. 1571.74 ± 404.6 units), mature oocyte ratio (0.78 ± 0.24 vs. 0.82 ± 0.26), and modified follicle oocyte index (0.86 ± 0.63 vs. 0.84 ± 0.19). In the TUGOR group, superficial epigastric artery injury occurred in two patients and resolved spontaneously. Transabdominal oocyte retrieval using a vaginal ultrasound is a safe, effective, and feasible method of oocyte retrieval in some selected patient groups.

Femoral tripod arteries: Surgical anatomic variants.

To describe the surgical anatomy of the femoral tripod arteries and their anatomical variants. Patients who underwent vascular surgery by external arciform approach of the Scarpa between May 2022 and July 2022 were selected. The surgical anatomy was assessed by direct observation. The origin and the course of major branches of the femoral artery (FA) were studied. Diameters and the distance of the origin of the femoral profunda artery (FPA) from the midpoint of the inguinal ligament was measured in millimeters and recorded. The observed anatomical variations were photographed and compared to those in the literature. A total of 40 patients (34 men, 85%) were included. The median diameter of the common femoral artery (CFA) was 9mm (IQR: 7-12mm). The Modal bifurcation was noted in 95% of cases. The collateral branches of the CFA were found to be distributed as follows: the superficial circumflex iliac artery (SCIA) in 34 cases (85%), the superficial epigastric artery (SEA) in 22 cases (55%), the deep external pudic artery in 16 cases (40%), and the superficial external pudic artery in 18 cases (45%). The median diameter of the FPA was 5mm (IQR: 4-6mm). The FPA originated from the posterolateral side of the CFA in 90% of cases, from the posterior side in 5% of cases and from the medial side in 5% of cases. The median diameter of the SFA was 6mm (IQR: 4-9mm). The anatomic variants of the femoral tripod arteries are extremely frequent. Therefore, it is important to recognize the anatomy in order to avoid possible diagnostic errors and to minimize the risk of per and post procedural complications.

Intraoperative study of the functional perforasome - an experimental model.

The aim of this study is to find the most suitable protocol based on an animal experimental model, through the use of a fluorescent dye, determining also its minimal concentration needed to stain the skin after arterial injection, in order to evidence the functional perforasome by visual examination. Methylene blue solution was used in order to determine the territory vascularized by one perforator on fresh cadavers in many studies which introduced, as a final result, the concept of perforasome. One of the most frequent complications of perforator flaps is partial flap necrosis which could be avoided by correctly assessing pre-operatively the functional perforasome surface.Two groups of seven rats were used in order to establish a proper surgical protocol to evaluate the functional perforasome in vivo by injecting the dye. Also, the minimal concentration for methylene blue was experimentally determined. The direct injection into the femoral artery of the proper concentration of dye, 1mM for methylene blue and the clamping of all the branches except the medial branch of the superficial epigastric artery is a reliable model to study the functional perforasome. Our study demonstrates that the intraoperative assessment with fluorescent dye of the functional perforasome by intra-arterial injection of methylene blue is an easy, affordable and very efficient method to reduce the number of partial necrosis of the perforator flaps.

Arterial Occlusion After Hyaluronic Acid Injection: Treatment With Hyaluronidase and Streptokinase.

The most feared complication of the hyaluronic acid injections in the periorbital region is embolism of the central retinal artery. The present study aimed to compare the effectiveness of hyaluronidase administered intravenously (systemically) alone or in combination with streptokinase with that of intra-arterial revascularization. Thirty rats were divided into 5 groups. The bilateral oblique groin flap of the rats was raised; the right side was the experiment group, and the left side was the sham control. The right superficial epigastric artery was occluded with a hyaluronic acid injection. After occlusion, no additional procedures were performed in group 1, whereas group 2 received systemic hyaluronidase, group 3 received intra-arterial hyaluronidase, group 4 received systemic hyaluronidase and streptokinase, and group 5 received intra-arterial hyaluronidase and streptokinase. On the seventh day, the rats were killed, flap necrosis rate was calculated, and histological examination was performed. There was no significant difference in the necrosis rates of the rats in groups 2, 3, 4, and 5 (P > 0.05). In histological evaluation, the histological view closest to normal arterial structure was observed in group 4. Immunohistochemical analysis revealed that the ischemia scores of systemic therapy were significantly lower than those of intra-arterial therapy. These results have shown that hyaluronidase and streptokinase administered systemically is as effective as intra-arterial revascularization and does not cause arterial wall degeneration. It has been shown that systemic administration of hyaluronidase and streptokinase is as successful as intra-arterial revascularization in the treatment of arterial embolism with hyaluronic acid.

Hydroxyapatite incorporation into polyamide membrane

The synthesized hydroxyapaptite (HA) by the precipitation method and incorporated it into polyamide (PA) membrane obtained by additive manufacture. HA formation and incorporation were confirmed by X-ray diffraction, which revealed peaks corresponding to synthetic HA. The infrared spectra displayed the characteristic HA bands between 1093 and 1032 cm−1, ascribed to phosphate ions (PO43−). After HA incorporation, the membranes were sterilized by using ethylene oxide or an autoclave. Characterization confirmed that HA was present in PA. Cytotoxicity tests did not detect any cytotoxicity for HA, PA, or PA + HA. After incorporation with hydroxyapatite, the membranes were allocated into surgical degrees, sterilized in autoclave and ethylene oxide, and subsequently placed in three distinct intracorporeal sites (subcutaneous tissue close to the right caudal superficial epigastric artery, greater omentum, and tissue surrounding the femur) in rats. None of the rats died during the experiment. After the animals were euthanized, intracorporeal site samples were collected for histological analyses. Neovessels were formed in the proximity of the membranes, and the membranes adhered to the bone. The results indicated that additive manufacturing is important to prepare materials that can be employed in bone implants after these materials undergo appropriate treatment.

Combining a Vascular Bundle and 3D Printed Scaffold with BMP-2 Improves Bone Repair and Angiogenesis.

Vascularization is currently considered the biggest challenge in bone tissue engineering due to necrosis in the center of large scaffolds. We established a new expendable vascular bundle model to vascularize a three-dimensional printed channeled scaffold with and without bone morphogenetic protein-2 (BMP-2) for improved healing of large segmental bone defects. Bone formation and angiogenesis in an 8 mm critical-sized bone defect in the rat femur were significantly promoted by inserting a bundle consisting of the superficial epigastric artery and vein into the central channel of a large porous polycaprolactone scaffold. Vessels were observed sprouting from the vascular bundle inserted in the central tunnel. Although the regenerated bone volume in the group receiving the scaffold and vascular bundle was similar to that of the healthy femur, the rate of union of the group was not satisfactory (25% at 8 weeks). BMP-2 delivery was found to promote not only bone formation but also angiogenesis in the critical-sized bone defects. Both insertion of the vascular bundle alone and BMP-2 loading alone induced comparable levels of angiogenesis and when used in combination, significantly greater vascular volume was observed. These findings suggest a promising new modality of treatment in large bone defects. Level of Evidence: Therapeutic level I. Impact statement Vascularization is currently the main challenge in bone tissue engineering. The combination of a vascular bundle and an osteoinductive three-dimensional printed graft significantly improved and accelerated bone regeneration and angiogenesis in critical-sized large bone defects, suggesting a promising new modality of treatment in large bone defects.

A Case-control Analysis of the Knight's Move Technique in a Chicken Wing Microsurgery Model: Video Article.

A Case-control Analysis of the Knight's Move Technique in a Chicken Wing Microsurgery Model: Video Article.

Transabdominal ultrasound guided oocyte retrieval using vaginal ultrasound probe: Definition of the technique.

To define whether transabdominal ultrasound guided oocyte retrieval (TUGOR) is a feasible, effective and safe method. A total of 64 patients who underwent TUGOR in a tertiary referral university hospital in vitro fertilization (IVF) clinic were enrolled. Indications, total number of oocytes collected, total number and percentage of mature oocytes, duration of procedure, complication rates and total number of fertilized oocytes were assessed. The indications for TUGOR were as follows; virgin women with decreased ovarian reserve who opted fertility preservation (n = 52, 81.1%), Ewing Sarcoma (n = 1, 1.56%), breast cancer (n = 4, 6.2%), lymphoma (n = 1, 1.56%) endometrioma (n = 1, 1.56%), immature teratoma of the ovary (n = 1, 1.56%), multiple large uterine fibroids (n = 2, 3.1%), adnexal transposition due to bowel surgery (n = 1, 1.56%) and Mayer Rokitansky Küster Hauser Syndrome (n = 1, 1.56%). Total number of oocytes retrieved and mean number of oocytes collected were 315 and 4.92 ± 1.7 (range 1-21), respectively. The mean duration of the procedure was 12.4 ± 1.2 min. The number and percentage of mature oocytes were 272 and 86.3%, respectively. A total of 14 embryos were frozen in four patients and one blastocyst transfer was performed ending up with live birth. Superficial epigastric artery injury occurred in two patients and resolved spontaneously. No oocyte was retrieved in five patients with single growing follicle in the first attempt. TUGOR is a feasible, effective and safe method of oocyte retrieval for the purpose of fertility preservation or in patients with inaccessible ovaries via transvaginal route undergoing IVF.

Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects

To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.

Effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot

Objective: To explore the effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot and reconstructing the flexion and extension functions of wrist, finger, ankle, and toe. Methods: From February 2012 to March 2018, 4, 5, and 3 patients (11 males and 1 female, 23-62 years old) with skin and soft tissue defects on hand or foot were admitted to Traditional Chinese Medicine Hospital of Zhongmu County of Henan Province, Henan Armed Police Corps Hospital, and the Affiliated Jiangyin Hospital of Medical College of Southeast University, respectively. Five patients had hand defects, and 7 patients had foot defects. The areas of skin and soft tissue defects after debridement were 10 cm×8 cm-15 cm×10 cm. The ilioinguinal composite tissue flaps were designed and resected according to the wound area and the length of tendon defects, and the areas of flaps were 10 cm×8 cm-15 cm×12 cm. According to the specific condition of the recipient area, the superficial iliac circumflex artery in the tissue flap was reconstructed by end-to-side anastomosis in 2 patients and end-to-end anastomosis in 1 patient with ulnar artery, end-to-side anastomosis in 4 patients with the dorsal foot artery, end-to-side anastomosis in 2 patients with the posterior tibial artery, and end-to-end anastomosis in 1 patient with the external tarsal foot artery in the recipient area, and the superficial epigastric artery in the tissue flap was reconstructed by end-to-side anastomosis in 1 patient with the radial artery and end-to-end anastomosis in 1 patient with the ulnar artery in the recipient area. The donor sites were sutured directly or repaired with medium split-thickness skin grafts. The survival of tissue flap after the operation and the appearance, texture, and the two-point discrimination distance of the tissue flaps during follow-up were observed. The hand function and foot function were evaluated by the total active movement standard of hand and the Maryland foot score standard, respectively. Results: All the tissue flaps in 12 patients survived. During follow-up of 6-36 months after operation, the tissue flaps were slightly bloated, with linear scars at the junction site in the recipient area, and the two-point discrimination distances of the tissue flaps were 15-22 mm. The hand function was excellent in 3 cases, good in 1 case, and fair in 1 case, and the foot function was excellent in 4 cases, good in 2 cases, and fair in 1 case, and all the patients were satisfied with the function and appearance of hand or foot. Conclusions: The ilioinguinal composite tissue flaps can repair the hand and foot wounds and reconstruct the flexion and extension functions of wrist, finger, ankle, and toe at the same time, which is an effective method to repair this kind of defects.

Effects of arterial blood supply and venous return on multi-territory perforator flap survival

This study aimed to design arterial ischemic and venous congested areas on the same multi-territory perforator flap, assessing the effects of arterial blood supply and venous return on flap survival. Totally 68 rats were randomly divided into the experimental (Exp) and control (Con) groups. In the Exp group, flaps were based on left superficial epigastric artery and right superficial epigastric vein. In the Con group, flaps were based on the left superficial epigastric artery and vein. Immediate postoperative ink-gelatin angiography, epidermal metabolite levels detection, tissue edema measurement, survival rate evaluation in half of the flaps and average microvessel density assessment were performed. Blood in the Exp group flowed through most angiosomes, but only flowed around pedicled vessels in the Con group; metabolite levels of left halves in the Con and Exp groups were comparable with those of right halves. Angiosomes with high water contents occurred in the Exp group. Survival rates of left halves in the Con and Exp groups were higher than those of right halves, and more microvessels were found in the left ventral areas of both groups compared with the right ventral area in the Exp group. These findings revealed that on the same multi-territory perforator flap, arterial blood supply, affected by venous return, is a prerequisite for flap survival.

The exercise pressor reflex is inhibited by Brilliant Blue G in freely perfused and femoral artery ligated rats following intrathecal, but not hindlimb, treatment.

The exercise pressor reflex (EPR) is mediated in part by purinergic(P)2X receptors which are compromised of seven subtypes. Blockade of the P2X3 subtype on the peripheral endings of group III and IV muscle afferents attenuates the EPR. We investigated whether other P2X receptors were involved in the EPR arc in decerebrate Sprague Dawley rats whose femoral arteries were either patent or were ligated. We antagonized P2X receptors with Brilliant Blue G (BBG), which has highest affinity for P2X7 receptors. We injected BBG in both group of rats either intrathecally (50mg/mL; 25–50uL) or into the superficial epigastric artery, which is a side branch of the femoral artery. Intrathecal injection of BBG attenuated the magnitude of the EPR in both rats with patent femoral arteries and in rats with ligated femoral arteries (P&lt;0.05). Intrathecal injection of BBG had no effect on the pressor response to intra‐carotid injection of sodium cyanide (2ug), which is a potent and selective stimulant to carotid chemoreceptors. This latter finding indicates that intrathecal injection of BBG did not ascend to the medulla and did not impact the spinal sympathetic outflow. BBG injected either into the superficial epigastric artery or intravenously (5mg) had no appreciable effect on the EPR. In addition the effect of intrathecal BBG could not be explained by “neural fatigue” caused by repetitive contractions in rats with ligated femoral arteries. We conclude that intrathecal BBG treatment inhibits the EPR by antagonizing P2X4 or P2X7 receptors within the dorsal horn of the spinal cord.Support or Funding InformationThis study was funded by NIH grants R01 AR 059397 and P01 HL 134609.

Predicting the Feasibility of Utilizing SIEA Flap for Breast Reconstruction with Preoperative BMI and Computed Tomography Angiography (CTA) Data.

Diameters greater than 1.5mm are considered one of the generally accepted criteria for utilizing superficial epigastric artery (SIEA) flaps for breast reconstruction. However, this standard fails to consider individual differences among patients or deep inferior epigastric perforator (DIEP) perfusion of the same angiosome as the SIEA. This study combined the SIEA system with the DIEP system and explored the relationship between the two systems and body mass index (BMI) to theoretically provide a reference for flap choice in the preoperative surgical plan. This study analysed preoperative computed tomography angiography (CTA) data from patients who received systematically postoperative treatment for unilateral breast cancer and were scheduled for breast reconstruction from 2013 to 2018 in our centre. All patients included had no past medical history that might have influenced the diameter of the SIEA, and their CTA data showed the presence of SIEA. Twenty-five females with a mean BMI of 23.6 ± 3.3kg/m2 were included. A total of 30 hemi-abdomens identified with the SIEA were assessed. The measured mean diameter of the SIEA was 1.63 ± 0.55mm, showing a highly linear correlation with BMI (r = 0.73, p < 0.001), while the maximum diameter of the deep inferior epigastric perforator (DIEPmax) and the number of dominant perforators originating from the deep inferior epigastric artery (DIEA) were not related to BMI. It was analysed from the equation between the calibre of the SIEA and BMI that when the BMI was greater than or equal to 24kg/m2, the minimum diameter of the SIEA was at least 1.5mm; when the BMI was 25kg/m2, the diameter of the SIEA was, at most, 2.0mm. Based on the linear correlation described above, we proposed that if the diameter of the SIEA was greater than or equal to 2.0mm, a BMI ≥ 25kg/m2 could be fully guaranteed. In terms of the advantageous single pedicle for reconstruction, the ratio of the SIEA diameter to DIEPmax (SIEA/DIEPmax) showed a significant linear correlation with BMI (r = 0.82, p < 0.001), and when the BMI was greater than or equal to 25kg/m2, the lower limit of its predicted value was above 1.0; in other words, the SIEA diameter was advantageous compared with DIEPmax for the use of a single pedicle. In terms of perfusion, the SIEA system was positively correlated with BMI (p < 0.001), while the DIEP system was not. The difference in perfusion level between the SIEA and DIEP systems showed a positive correlation with BMI (p = 0.001), while the sum of the two systems only tended to be correlated, without statistical significance (p = 0.06). For patients with a BMI ≥ 25kg/m2 or an SIEA diameter ≥ 2.0mm, application of an SIEA flap is theoretically a preferable choice in preoperative surgical planning for breast reconstruction. And the patients should meet two conditions: the first one is the absence of past medical history that might potentially influence the diameter of the SIEA; the second is the presence of the SIEA, which has already been shown by the preoperative imaging data. Through perfusion-related studies, we propose that the SIEA is likely a compensatory vessel that is inclined to present in people with larger BMIs. 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 .

Perforator Mapping of the Superficial and Deep Inferior Epigastric Artery in the Abdominal Region of the Vietnamese.

BACKGROUND:Previous studies worldwide have investigated the anatomy of the perforators of the deep inferior epigastric arteries to figure out the navigation patterns of the perforators on the abdominal wall. This has been inconsistent amongst the researchers about how to select the perforator to increase the blood supply area for the flap.AIM:To explore the blood supply area of the perforators of the superficial and deep inferior epigastric artery in the abdominal region of the Vietnamese by dissection and 64-slice multislice computed tomography (64-slice MSCT).METHODS:A descriptive cross-sectional study Center from September 2014 to September 2016 on two groups including 30 cadavers fixed by formalin 10% in Anatomy Department of UPNT, and 37 patients getting the 64-slice MSCT abdominal arteries angiogram.RESULTS:The superficial epigastric arteries at the level of the inguinal ligament were located in the middle region, with 96% (right) and 88.5% (left). The anterior superior iliac spine level was in the middle, and lateral regions of 68% and 32% respectively. The level of the umbilical cord was in the lateral region with 66.7% and 85.7%, respectively. There were about 6 perforators of the deep inferior epigastric arteries located in the navel area. These perforators were 70% in the medial region and 30% in the middle region.CONCLUSION:Mapping the blood supply based on the fourth space in the abdominal region in which the superfical inferior epigastric arteries supplied the lateral area. The middle and the internal ones were the perforators of the deep inferior epigastric arteries.

Preconditioning with one-time hydrogen gas does not attenuate skin flap ischemia-reperfusion injury in rat models

Hydrogen gas exists in the atmosphere and was previously considered an inert gas. It has been reported to have protective effects on tissue ischemia-reperfusion (IR) injuries in animal models. The protective mechanism of hydrogen molecules is based on selectively reducing highly strong oxidants in cells, thereby reducing inflammation and decreasing the contents of MDA, FOXO3a, and other pathways that result in flap necrosis. Previous studies were conducted with postconditioning with hydrogen. In this article, we want to investigate whether inhalation of hydrogen has a preventive effect on IR injury. Forty-five adult male Sprague Dawley rats (body weight 220-250 g) were randomly divided into three groups: (1) Sham operation group (SH), (2) Ischemia-reperfusion injury group (IR), and (3) Ischemia-reperfusion injury with preconditioning hydrogen group (PRH). IR injury was induced by clamping the right superficial epigastric artery for 3h. Before undergoing 3h of IR management, the PRH group was treated with hydrogen inhalation for 1 h. On the third postoperative day, survival area and blood perfusion of the flap were assessed using laser Doppler flowmetry. RIP1 and RIP3 were examined by immunological detection and western blot analysis. Both the IR and PRH groups had less skin flap survival area and less blood perfusion than the sham group (P<0.05). RIP1 and RIP3 were highly expressed in the IR and PRH groups when compared with those in the SH group (P<0.05). There were no significant differences in flap survival rate (32.34±2.19% and 33.09±1.64%), average blood perfusion (41.66±3.53pu, 48.57±2.83pu), and expression of RIP1 and RIP3 (0.5167±0.1409 and 0.4693±0.1454) between the IR and PRH groups. Preconditioning with one-time inhaled hydrogen does not attenuate skin flap IR injuries in rat models.

Stimulation of spinal δ-opioid receptors attenuates the exercise pressor reflex in decerebrate rats

A reflex arising from contracting hindlimb muscle is responsible in part for the increases in arterial pressure and heart rate evoked by exercise. The afferent arm of this reflex comprises group III and IV afferents. δ-Opioid receptors are expressed predominately on the spinal endings of group III afferents, whereas μ-opioid receptors are expressed predominately on the spinal endings of group IV afferents. Using stimuli that activated group III afferents, namely static contraction, calcaneal tendon stretch, and lactic acid injection into the superficial epigastric artery, we tested the hypothesis that, in rats with either patent or ligated femoral arteries, activation of pre- and postsynaptic δ-opioid receptors in the dorsal horn attenuated pressor reflex responses to these stimuli. In rats with patent arteries or ligated femoral arteries, [d-Pen2,5]enkephalin (DPDPE), a δ-opioid agonist injected intrathecally (10 μg in 10 μl), significantly attenuated the pressor responses to contraction, stretch, and lactic acid (all P < 0.05). Naltrindole, a δ-opioid receptor antagonist, prevented the attenuation. In contrast, DPDPE did not attenuate the pressor response to capsaicin injection into the superficial epigastric artery in either group of rats (both P > 0.05). Intrathecal injection of saline (10 μl), the vehicle for DPDPE, had no effect on the pressor responses in either group of rats. We conclude that activation of spinal δ-opioid receptors attenuates reflexes evoked by group III afferents in both freely perfused and ligated rats.

Dissection of the Common Femoral Artery at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to determine the dimensions of CFA before the birth of the deep thigh artery, describe the mode of termination of the CFA, search for CFA collaterals, and describe the anatomical variations of the CFA. Methodology: This was a prospective study conducted at the Anatomy Laboratory of the Faculty of Medicine and Odonto-Stomatology of Bamako. CFA arteries of 12 fresh corpses of adults include 9 men and 3 women. A total of 24 CFA arteries were dissected and photographed. Results: The mean length of CFA was 50.9 ± 12.55 mm (range: 31 and 93 mm). Its average diameter was 9.12 ± 1.17 mm (range: 7 and 12 mm). In 70.83%, the CFA artery ended without any particularity. There was 29.17% anatomic variation in the CFA termination mode. The CFA divided into 3 branches (trifurcation) in 25%. The 3 branches were in 20.83%, the FS and a common core to LFCA and AQ; in 4.17%, they were the SFA, the DFA and the MFCA. In 4.17%, it divided into 4 branches which are: the SFA, the DFA, the MFCA and a common core to QA and LFCA. The CFA gave as collateral: circumflex superficial iliac artery in 22 cases (91.67%), superficial epigastric artery in 19 cases (79.17%), upper external pudendal artery in 20 cases (83.33%), and lower external pudendal artery in 14 cases (58.33%). We noted in our series 9 anatomical variations at the collateral level of the CFA or 37.5%. The CFA gave birth to the following branches: the MFCA in 4 cases or 16.67%, the LFCA in 1 case or 4.17%, the QA in 1 case or 4.17%, and a common core to the QA and LFCA in 3 cases or 12.5%. Conclusion: The length of CFA is important. The variations of CFA are frequent and important to know in clinical and surgical practice.