Vascular Axis Research Articles

Abstract: Anatomic Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomography Angiography (CTA)

INTRODUCTION: The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer (VLNT). The actual anatomic details related to the gastroepiploic vascular axis and lymph nodes (LN) have not been investigated. The purpose of this study is to describe the right gastroepiploic artery (GEA) and related structures by using computed tomography angiography (CTA). METHODS: A retrospective analysis was conducted on ten patients with no known abdominal or pelvic malignancy who received CTA. These scans were reviewed for objective donor-site characteristics by one reviewer (CH). Statistical models were used to identify the specific LN basin and right GEA characteristics. RESULTS: The right GEA was identified in nine of ten patients. It was found to have an average diameter of 2.98mm at its origin (SD0.89, range 1.7–4.4). The distance from right to left GEA origin was 17.9cm (SD6.34, range 10.3–29.9). The gastroduodenal artery length prior to right GEA takeoff was 3.78cm (SD1.29, range 2.19–5.92). Nine patients had identifiable lymph nodes in the right GEA lymphosome. There were 3.3 LNs identified per patient (SD3.0, range 0–10). The average distance from each LN to the right GEA origin was 7.50cm (SD3.51, range 2.04–15.4). The distance from the right GEA origin to the most proximal LN was 4.13cm (SD1.65, range 2.04–7.13). The distance from the GEA origin to the third LN was 8.91cm (SD2.90, range 7.11–13.2). Each LN was within 8.55mm (SD7.9, range 1–28.7) of the right GEA. CONCLUSION: The gastroepiploic VLNT may be a valuable option when selecting a donor site for the surgical treatment for lymphedema. On average, three lymph nodes exist along the right GEA, which is comparable to other favorable and commonly used donor sites. When using the right GEA donor site for VLNT, the plastic surgeon should anticipate using a pedicle length of no more than 4cm, a total flap length of 9cm with a 3cm cuff of tissue in order to obtain at least 3 lymph nodes for transfer. CTA is an effective imaging modality that can be used to preoperatively plan for vascularized lymph node transfer.

Pre- and neonatal imaging of gastrointestinal complications in congenital diaphragmatic hernia

The initial outcome in infants with congenital diaphragmatic hernia is mainly related to the associated lung hypoplasia. However, these patients frequently present with additional gastrointestinal pathology that also influences their quality of life and final prognosis. Congenital gastrointestinal anomalies are often observed and the displacement of the liver, the stomach and/or the intestines into the thorax may cause distortion of the vascular axis of these organs, increasing the risk of congestion and/or ischemia. Some of these gastrointestinal complications are already visible at imaging studies performed in utero and/or in newborns.This pictorial essay describes the imaging findings of the most frequently detected gastrointestinal complications in fetuses and infants with congenital diaphragmatic hernia, focusing on prenatal exams.

A Rare Case of Twisted Ovarian Cyst in Term Gestation Patient

Introduction: Torsion of ovarian cyst is defined as total or partial rotation of adnexa around its vascular axis or pedicle. We may get difficulty in diagnosis in term gestation patient because of gravid uterus and symptoms of onset of labour mimicks the symptoms of twisted ovarian cyst. Method: Case Report 32 year G3P2L2 with 38 weeks of gestation with complain of pain in abdomen and nausea since previous day. H\O same complains twice in last month which was diagnosed as preterm labour pain and treated accordingly in other hospital. She presented herself in latent phase of labour. During monitoring, she was having continuous abdominal pain and episodes of vomiting twice. Decision of emergency L.S.C.S taken in view of fetal distress and non progress of labour. But while exploring the abdominal cavity, twisted ovarian cyst of size 10 x 8 cm in right adnexa found. Right sided Salpingoophorectomy done without untwisting the pedicle. Conclusion: Twisted ovarian cyst is usually symptomatic in pregnancy. but here because of Gravid Uterus, It remained undiagnosed till term gestation and required right salpingoophorectomy during L.S.C.S.

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group.

The Relationship of Superficial Cutaneous Nerves and Interperforator Connections in the Leg: A Cadaveric Anatomical Study.

The lower limb is a source of many flaps both for closure of local defects and for free transfer. Fasciocutaneous flap techniques have been progressively refined, although the vascular basis for their success needs clarification. Archival studies of 48 lower limbs were reviewed and combined with 20 studies of lower limbs from fresh cadavers, making a total of 68 investigations. Lower limbs were injected with a dilute lead oxide solution; the integument was removed and radiographed; and the cutaneous nerves were dissected, tagged with wire, radiographed again, and their paths traced on the original images. The major cutaneous nerves in the leg are paralleled by a longitudinal vascular axis often comprising long branches with large-caliber true anastomotic connections between perforators. The most highly developed vascular axes followed the medial sural cutaneous and saphenous nerves, together with their accompanying veins, immediately superficial to the deep fascia. The intervening areas were characterized by shorter branches usually connected by small-caliber choke anastomotic connections. These findings provide the anatomical basis for the observed reliability of longitudinal flaps in the leg. The superficial cutaneous nerves of the leg, especially the saphenous and medial sural cutaneous nerves, are paralleled by a vascular axis on or beside the nerve comprising long perforator branches connected usually but not always by large-caliber true anastomotic connections. This emphasizes the importance of understanding the characteristics of interperforator anastomoses when designing and raising flaps.

Abstract 73: Selective Isolation And Characterization Of Different Cell Types From Mammary Gland And Carcinoma Tissue For Subsequent Analysis Of Cell-cell Interactions

PURPOSE: Human normal breast and tumor tissues consist of a range of different cells such as epithelial, endothelial, mesenchymal and adipocyte cells. Simultaneous analyses of these different cell types from the same patient are missing, partly due to a lack of standardized cell isolation methods. With regard to the growing popularity of cell-assisted lipotransfer for breast reconstruction after tumor excision, implementing studies involving primary cell types instead of immortalized cell lines is of vital importance for understanding breast cell-cell interactions. METHODS: Five different primary cell types including mammary epithelial (MEC), mesenchymal (MES), adipose derived stem cells (ADSC) and endothelial cells (EC) from mammary (cancer) tissue and endothelial progenitor cells (EPC) from blood were simultaneously isolated and characterized by immunofluorescence, real-time PCR and differentiation. The interaction between ADSC and MEC and the influence of ADSC on MEC functional properties was investigated in indirect and direct co-culture assays such as proliferation, migration, transmigration, invasion and analyzed for gene expression. ADSC secreted factors were analyzed by antibody and quantibody arrays. Currently we have established an in vivo arteriovenous (AV) loop model in the rat, representing a novel approach for studying angiogenesis in breast tumor development and progression. The AV loop is transferred to an enclosed implantation chamber to create an isolated microenvironment in vivo, which is connected to the living organism only by means of the vascular axis. RESULTS: Successful fractionation of five different cell types from both human primary normal and tumor breast tissue and blood was performed. A molecular signature for MEC, MES and ADSC could be established. Comparative analysis showed higher gene expression of EPCAM, CD49f, CDH1, KRTs for normal MEC; MES for e.g. Vimentin, CD10, ACTA2, MMP9; ADSC for e.g. CD105, CD90, CDH2 and CDH11. EC and EPC showed typical endothelial properties such as tube formation, sprouting and acLDL-DiI uptake. Tumor ADSC showed impaired osteogenic and chondrogenic differentiation potential. In contrast, enhanced adipogenic differentiation was observed, where isolated conditioned media stimulated invasion; and heightened formation of endothelial-like structures we predict is linked with angiogenesis in the tumor microenvironment. ADSC significantly stimulated functional properties of MEC by secretion of a range of proteins. With the in vivo AV loop model, ongoing vascularization and tumor progression can be evaluated under standardized conditions like in a ‘living bioreactor’. CONCLUSION: This standardized protocol makes it possible to isolate different cell populations from the same breast (cancer) tissue leading to a better understanding of (tumor) breast cell biology. In further experiments the impact of EPC on breast cancer angiogenesis will be evaluated in co-culture with MEC, MES and ADSC. The innovative AV loop model will not only provide significant benefits for understanding breast cancer development and progression but can also be adapted for validation of cancer therapeutic drugs and for the development of new breast cancer therapies tailored to a patient’s specific requirements.

Platelets from pulmonary hypertension patients show increased mitochondrial reserve capacity.

Accumulating evidence suggests that altered cellular metabolism is systemic in pulmonary hypertension (PH) and central to disease pathogenesis. However, bioenergetic changes in PH patients and their association with disease severity remain unclear. Here, we hypothesize that alteration in bioenergetic function is present in platelets from PH patients and correlates with clinical parameters of PH. Platelets isolated from controls and PH patients (n = 28) were subjected to extracellular flux analysis to determine oxygen consumption and glycolytic rates. Platelets from PH patients showed greater glycolytic rates than controls. Surprisingly, this was accompanied by significant increases in the maximal capacity for oxygen consumption, leading to enhanced respiratory reserve capacity in PH platelets. This increased platelet reserve capacity correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and right ventricular stroke work index in PH patients and was abolished by the inhibition of fatty acid oxidation (FAO). Consistent with a shift to FAO, PH platelets showed augmented enzymatic activity of carnitine palmitoyltransferase-1 and electron transport chain complex II. These data extend the observation of a metabolic alteration in PH from the pulmonary vascular axis to the hematologic compartment and suggest that measurement of platelet bioenergetics is potentially useful in assessment of disease progression and severity.

Ovarian Torsion in Pregnancy: A Case Report

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. Although the exact etiology is unknown, common predisposing factors include moderate size cyst, free mobility and long pedicle. Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. Here, we report a case of ovarian torsion in pregnancy. Ovarian torsion is an urgent gynecological surgery and can occur during pregnancy. Surgical techniques should be considered in the development of the adnexal torsion regardless of the gestational age.

Characterization of Intestinal Ischemia/Reperfusion-Induced Decrease of Intestinal Glutathione

Intestinal ischemia followed by reperfusion has been widely studied, and oxidative stress generated by the production of reactive oxygen species is one major pathophysiological mechanism involved. The reduced form of glutathione (GSH) as part of the cellular antioxidant defense is affected during this process. The aim of this study was to perform a systematic study on the time course of intestinal GSH during intestinal ischemia, and ischemia followed by reperfusion (I/R) to clarify its role in I/R. Wistar rats were subject to laparotomy and ischemia achieved by clamping the intestinal vascular axis, and releasing the elastic band for the reperfusion period. Ischemia and I/R were monitored by surface oxygen and carbon dioxide electrodes. GSH was assayed by high pressure liquid chromatography. Our results showed thatischemia induced slight decreases in cecalGSH that could not be established as significant in the 120 min ischemia group. However, 5 and 30 min of reperfusion following different times of ischemia promoted a time-dependent decrease of GSH that reached 30% of control values. In conclusion, intestinal GSH may play a critical role during I/R in view of the correlation between its concentration after revascularization and the time of ischemia, which deserves further investigation.

Straightforward Method for Coverage of Major Vessels After Modified Radical Neck Dissection

A new method for covering the internal jugular vein and carotid artery after exposure of the cervical vascular axis subsequent to neck dissection is presented. To cover the most caudal part of the vascular axis, a platysma coli muscle flap is harvested from its most medial and inferior part of the neck in a caudally based fashion and is slightly rotated posteriorly up to 45°. In addition, a superiorly based sternocleidomastoid muscle flap involving the posterior half of the muscle after detachment of the clavicle head is harvested and rotated 45° anteriorly to cover the upper two thirds of the vascular axis. This technique seems to be a good alternative to the pectoralis major myocutaneous flap for covering cervical major vessels, if no classical radical neck dissection is performed, especially in those oncologic malnourished patients who will undergo adjuvant radiotherapy after surgical treatment.

The Arteriovenous (AV) Loop in a Small Animal Model to Study Angiogenesis and Vascularized Tissue Engineering.

A functional blood vessel network is a prerequisite for the survival and growth of almost all tissues and organs in the human body. Moreover, in pathological situations such as cancer, vascularization plays a leading role in disease progression. Consequently, there is a strong need for a standardized and well-characterized in vivo model in order to elucidate the mechanisms of neovascularization and develop different vascularization approaches for tissue engineering and regenerative medicine. We describe a microsurgical approach for a small animal model for induction of a vascular axis consisting of a vein and artery that are anastomosed to an arteriovenous (AV) loop. The AV loop is transferred to an enclosed implantation chamber to create an isolated microenvironment in vivo, which is connected to the living organism only by means of the vascular axis. Using 3D imaging (MRI, micro-CT) and immunohistology, the growing vasculature can be visualized over time. By implanting different cells, growth factors and matrices, their function in blood vessel network formation can be analyzed without any disturbing influences from the surroundings in a well controllable environment. In addition to angiogenesis and antiangiogenesis studies, the AV loop model is also perfectly suited for engineering vascularized tissues. After a certain prevascularization time, the generated tissues can be transplanted into the defect site and microsurgically connected to the local vessels, thereby ensuring immediate blood supply and integration of the engineered tissue. By varying the matrices, cells, growth factors and chamber architecture, it is possible to generate various tissues, which can then be tailored to the individual patient's needs.

Clinicopathology research and treatment of breast solid papillary carcinoma

Objective To study the clinicopathologic features, immunophenotype, diagnosis and differential diagnosis, prognosis and treatment of solid papillary carcinoma(SPC) of breast. Methods A retrospective study was performed to analyse the clinicalpathologic features and immunophenotype of 52 case of SPC, with or without invasion.The cytokeratins(CK), myoepithelial markers, neuroendocrine markers, proliferation marker Ki-67, estrogen receptor(ER), progesterone receptor(PR), HER2, ect were detected by immunohistochemical staining, and HER2 was detected by FISH.All patients were followed up. Results All the patients were females with a mean age of (66.76±10.19) years.The incidence of SPC among all the breast cancers in this department was 0.99%.The presenting symptoms was a painless mass with or without nipple discharge in the central of breast.All of them accepted surgical resection, 13 cases were administrated with chemotherapy after surgery, 6 cases were radiotherapy.Metastasis was observed four in 34 cases who had undergone axillar lymph node dissection.General observation tumor was substantive and nodular lesions, may be accompanied by cyst formation, microscopy tumor for swelling, substantive nodules within only fine fiber vascular axis, and lacked obvious nipples and screen structure.The cells were lack of atypia, adhesive in cells nest, 35 patients were accompanied with mucus secretion.Immunohistochemical study show that the tumor cells experssed CK8/18, ER and PR, but not basal cell cytokertin CK5/6 and 34βE12.Positivity for CK5/6, 34βE12 and P63 were 5.78%, 9.62% and 7.69% in the myoepithelial layers of axis of papillary, and were 21.15%, 38.46% and 19.23% in cell nests and tumor peripheral myoepithelial, respectively.Positivity for CgA, Syn, NSE, CD56 were 82.69%, 88.46%, 94.23% and 90.38%, respectively.The staining of HER2 oncoprotein was most negative, and 23 cases of FISH detection were all negative.The average positive index of Ki-67 was 4.28%.47 cases received follow-up of patients(90.38%), only 1 case death, 1 case recurrence the rest were no tumor recurrence or metastasis, disease-free survival. Conclusion SPC of breast, a rare pathologic type, usually occurs in old females.The diagnosis depends on pathological characteristics and its unique immune phenotypic characteristics, is closely associated with mucinous carcinoma and neuroendocrine carcinoma, and the treatment is given priority tosurgery with a relatively inert biological behaviour. Key words: Breast neoplasms; Carcinoma, Papillary; Pathology, Clinical

Three-dimensional mapping of the arteriovenous loop model using two-dimensional histological methods.

The aim of this study was to create an analytical tool for the three-dimensional distribution of immunohistochemically stained cells in the arteriovenous (AV) loop model of the femoral vessels of rats that fuses two-dimensional histological slides into stacks. A total of 22 AV loops were implanted into male syngeneic Lewis rats by creating an arteriovenous fistula between the femoral artery and vein by interposing a femoral vein graft of the contralateral extremity. This fistula was embedded into an isolation chamber filled with a fibrin matrix. Specimens were explanted after 7 to 14 days, and the AV loop was processed using standard histological protocols. Immunohistochemical staining for HIF-1α and a counter staining with hematoxylin was performed. Various layouts with different cutting planes, regions of interest, and post-processing algorithms were evaluated. Results and observations: The proximal-to-distal cutting perpendicular to the vascular axis proved to be the best layout for mapping the three-dimensional constructs containing the AV loop. A semi-automatic algorithm for the differentiation of immunohistochemical positive and negative cells was developed. The newly established methods from this study constitute an excellent tool for the general evaluation of the AV loop model - particularly with regard to the three-dimensional distribution of immunohistochemical positive and negative cells.

A clinicopathologic analysis of 31 patients with solid papillary carcinoma of breast

Objective To study the clinicopathologic features, immunophenotype, diagnosis and differential diagnosis of solid papillary carcinoma (SPC) of breast. Methods A retrospective study was performed to analyse the clinicopathologic features and immunophenotype of 31 cases of SPC with or without invasion. The cytokeratins (CK), myoepithelial markers, neuroendocrine markers, proliferation marker Ki-67, estrogen receptor (ER), progesterone receptor (PR), HER2, ect were detected by immunohistochemical staining, and HER2 was detected by FISH. All patients were followed up. Results All the patients were females with a mean age of (67.0±12.5) years. The presenting symptom was a painless mass with or without nipple discharge. In 19 cases who had undergone axillar lymph node dissection, only one metastasis was observed. General observation showed that tumors had substantive and nodular lesions, accompanied by cyst formation. Microscopy examination showed that tumors had swell and substantive nodules with only fine fiber vascular axis, and lacked obvious nipples and screen structure. The cells were lack of atypia,adhesive in cells nest. 20 patients were accompanied by mucus secretion. Immunohistochemical study showed that the tumor cells expressed CK8/18, ER, PR, but didn't express basal cell CK5/6, 34β12. The positive rates of CK5/6, 34β12, p63 were 3.23 % (1/31), 9.68 % (3/31), 6.45 % (2/31) in the myoepithelial layers of axis of papillary, and were 19.25 % (6/31), 38.71 % (12/31), 16.13 % (5/31) in peripheral cell nests and tumors, respectively. The positive rates of CgA, Syn, NSE, Cd56 were 83.87 % (26/31), 87.10 % (27/31), 93.55 % (29/31), 90.32 % (28/31), respectively. The staining of HER2 oncoprotein was negative mostly, and the FISH detection outcome of 15 cases were all negative. The average positive index of Ki-67 was 4.12 %. 28 cases (90.23 %) received follow-up, only 1 patient died, and the rest patients were without tumor recurrence or metastasis. Conclusions SPC of breast, a rare pathologic type, usually occurs in old females. The diagnosis depends on pathological characteristics and its unique immune phenotypic characteristics. SPC of breast has close relationship with mucinous carcinoma and neuroendocrine carcinoma,with a relatively inert biological behavior. Key words: Solid papillary carcinoma of breast; Clinicopathologic; Immunophenotype; In situ hybridization, fluorescence; Prognosis

Acute toxicity and histopathological changes in liver and gill epithelium of African Catfish (<i>Clarias gariepinus</i>) juveniles exposed to mercuric chloride

Acute toxicity of mercuric chloride (HgCl 2 ) on Clarias gariepinus juveniles was assessed. A total of 180 fish of mean weight 31.07±1.23 g and mean length 19.50±0.50 cm were divided into six groups of ten fish each of three replicates. The juveniles were exposed to different concentrations of 0.00 (control), 1.20, 1.40, 1.60, 1.80 and 2.00 mg/L for a period of 96 hours. Juveniles in the control group survived while those exposed to 1.80 and 2.00 mg/L died. Determination of 96 hours LC 50 was carried out by computing mortality results in Probit program of SPSS (version 17.0). Median lethal concentration was 1.492 mg/L with lower and upper confidence limits of 1.44 mg/L and 1.59 mg/L respectively at 95%. Liver and gill samples were collected after 4 days of exposure to HgCl 2 and lesions were analyzed by light microscopy. Main histopathological changes observed in gills exposed to highest concentration were edema, lifting of lamellar epithelia and an intense vasodilatation of lamellar vascular axis. Although less frequent, lamellar fusion caused by filament epithelium proliferation and some lamellar aneurisms were also found. Liver of control group exhibited a quite normal architecture, while fish exposed to HgCl 2 showed vacuolation and necrosis. Keywords: Toxicology, histopathology, mortality, mercuric chloride, Clarias gariepinus

A Modified Technique to Improve Reliability of Distally Based Sural Fasciocutaneous Flap for Reconstruction of Soft Tissue Defects Longitudinal in Distal Pretibial Region or Transverse in Heel and Ankle

Partial flap loss is a common complication of the distally based sural fasciocutaneous flap. We present a modified technique of a sloped skin island design to improve the reliability of the flap when used to reconstruct a longitudinal distal pretibial defect or transverse heel and ankle defect. Thirty-one flaps with the slope-designed skin island were used to reconstruct such defects in 30 patients. In the modified technique, the skin island was rotated toward the vascular axis of the flap. The defects were located in the distal pretibial region in 7 cases and the ankle and heel region in 24. The horizontal dimension of the skin island decreased by an average of 5.6 (range 2.5 to 14.8) cm with the sloped design, and the rotation angle varied from 42° to 90° (mean 69°). Of the 31 flaps, 29 survived, 1 developed marginal necrosis, and 1 developed lateral partial necrosis. The sloped design of the skin island is applicable to reconstruction of longitudinal distal pretibial or transverse heel and ankle defects. The modified technique can decrease the horizontal dimension and increase perfusion of the skin island, thus improving the reliability of the flap.

The Folded Ulnar Forearm Flap for Nasal Reconstruction

Many strategies exist to reconstruct composite nasal defects, but free flaps are necessary for extensive defects. The workhorse radial forearm flap is hair-bearing and donor-site cosmesis is unfavorable. The ulnar forearm flap is overlooked despite important aesthetic benefits. The authors describe their experience with the ulnar forearm flap, with a novel folding technique in staged nasal reconstruction. Between December of 2010 and April of 2015, 10 nasal reconstructions in five men and five women were performed. Average patient age was 47.6 years (range, 31 to 76 years). The ulnar forearm flap was designed as a narrow contiguous flap along the ulnar vascular axis. Inset began with the nasal floor; the flap was then tubularized twice to create nasal passages before it was folded on itself for coverage. Caudal edges were sewn together to create alae and a columella. Follow-up time, complications, number of operations, and reconstructive duration were documented. Average follow-up was 25.2 months (range, 18 to 44 months). Patients had satisfactory aesthetic and functional outcomes after 6.4 operations (range, five to eight) over 11.1 months (range, 8 to 18 months). Partial necrosis of the alar lining in one case was salvaged with the covering flap. Two cases of chondritis were managed with conservative débridement and antibiotics. One case of severe chondritis necessitated removal and de novo reconstruction. The ulnar forearm flap is safe and reliable in nasal reconstruction, with superior donor-site cosmesis. The tubular folding method creates a vascular envelope amenable to same-stage framework construction. With thoughtful planning and sufficient refinement, excellent aesthetic and functional results are achievable. Therapeutic, V.

The assessment of the clinical applications of propeller flaps of the lower leg

Objective The aim of the present study was to assess the clinical applications of the various propeller perforator flaps for the leg in an attempt to evaluate the results and propose an algorithm for the management of various defects of the lower-third of the leg. Background The ideal method for the soft-tissue reconstruction of the leg should be reliable, relatively easy to perform, offer viable tissues similar in skin texture and thickness to the lost ones (replace like with like), leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. The perforator-based propeller flaps have all these advantages. Patients and methods This study included 34 patients who presented with moderate-sized leg defects from August 2013 to June 2015. Out of the 34 patients, 24 were males and 10 were females. Their ages varied from 5 to 50 years with an average age of 27 years. There were 19 posterior tibial artery perforator flaps. There were 12 flaps based on perforators of the peroneal artery. Lastly, there were three anterior tibial artery perforator flaps. Duplex ultrasonography was carried out for 25 patients preoperatively. Results All flaps were based on a single perforator except three cases in which the flaps were based on two adjacent perforators. Fourteen of the flaps were proximally based and 20 were distally based. All flaps were designed as propeller flaps and were rotated from 70° to 180°. The donor site was closed by using split-thickness grafts in all except three cases in which the donor site was closed primarily. Out of the 19 flaps of the posterior tibial artery, 11 (57.5%) healed uneventfully and eight (42.5%) cases were complicated. Out of the 12 peroneal artery propeller flaps, nine (75%) flaps healed uneventfully and three (25%) cases were complicated. Lastly, out of the three cases of the anterior tibial artery propeller flaps, one (33%) healed uneventfully and two (66%) were complicated. Conclusion Propeller flaps based on perforator vessels are raising interest in the reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows the reconstruction of soft-tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of propeller perforator flaps in the treatment of various lower-leg defects.

Ultrasound-guided photoacoustic imaging-directed re-endothelialization of acellular vasculature leads to improved vascular performance

As increasing effort is dedicated to investigating the regenerative capacity of decellularized tissues, research has progressed to recellularizing these tissues prior to implantation. The delivery and support of cells seeded throughout acellular scaffolds are typically conducted through the vascular axis of the tissues. However, it is unclear how cell concentration and injection frequency can affect the distribution of cells throughout the scaffold. Furthermore, what effects re-endothelialization have on vascular patency and function are not well understood. We investigated the use of ultrasound-guided photoacoustic (US/PA) imaging as a technique to visualize the distribution of microvascular endothelial cells within an optimized acellular construct upon re-endothelialization and perfusion conditioning. We also evaluated the vascular performance of the re-endothelialized scaffold using quantitative vascular corrosion casting (qVCC) and whole-blood perfusion. We found US/PA imaging was an effective technique to visualize the distribution of cells. Cellular retention following perfusion conditioning was also detected with US/PA imaging. Finally, we demonstrated that a partial recovery of vascular performance is possible following re-endothelialization—confirmed by fewer extravasations in qVCC and improved blood clearance following whole-blood perfusion. Statement of SignificanceRe-endothelialization is a method that enables decellularized tissue to become useful as a tissue engineering construct by creating a nutrient delivery and waste removal system for the entire construct. Our approach utilizes a decellularization method that retains the basement ECM of a highly vascularized tissue upon which endothelial cells can be injected to form an endothelium. The US/PA method allows for rapid visualization of cells within a construct several cm thick. This approach can be experimentally used to observe changes in cellular distribution over large intervals of time, to help optimize cell seeding parameters, and to verify cell retention within re-endothelialized constructs. This approach has temporal and depth advantages compared to section reconstruction and imaged fluorophores respectively.

Sarcoma of the Thigh: Radical Excision with Arterial Reconstruction Using the Contralateral Saphenous Vein

Soft tissue sarcomas are a heterogeneous group of malignant mesenchymal neoplasms that frequently affect large muscle of the thigh. A conservative limb-salvage surgery involving en bloc resection of the whole tumor with surrounding healthy tissue can sometimes be considered instead of amputation to achieve good local disease control while preserving a satisfying function of the affected limb. The massive vascular encasement, once regarded as a contraindication to limb-salvage surgery, can sometimes be encompassed thanks to vascular axis reconstruction. Although no doubt exists about the need for reconstruction of the femoral artery with quite good reported results, the venous replacement is a controversial issue with unclear patency rates, yet this replacement is mandatory when superficial and deep femoral veins are removed together with the saphenous vein. The femoral artery is commonly replaced with an autologus reversed saphenous vein graft because of its resistance to infections and its excellent patency rates compared with artificial grafts. We present a case of thigh sarcoma involving the femoral vascular axis with complete clogging of the femoral vein due to massive deep thrombosis. The video illustrates the features of the case and highlights the steps of a wide compartment resection with arterial reconstruction by autologus reversed saphenous vein graft.