Blood supply of subcutaneous tissue in the leg and its clinical application

Overview of Biofluids and Flow Sensing Techniques Applied in Clinical Practice

This review summarizes the current knowledge on biofluids and the main flow sensing techniques applied in healthcare today. Since the very beginning of the history of medicine, one of the most important assets for evaluating various human diseases has been the analysis of the conditions of the biofluids within the human body. Hence, extensive research on sensors intended to evaluate the flow of many of these fluids in different tissues and organs has been published and, indeed, continues to be published very frequently. The purpose of this review is to provide researchers interested in venturing into biofluid flow sensing with a concise description of the physiological characteristics of the most important body fluids that are likely to be altered by diverse medical conditions. Similarly, a reported compilation of well-established sensors and techniques currently applied in healthcare regarding flow sensing is aimed at serving as a starting point for understanding the theoretical principles involved in the existing methodologies, allowing researchers to determine the most suitable approach to adopt according to their own objectives in this broad field.

New Discoveries in Anatomy and New Terminology of Leg Veins: Clinical Implications

Advances in diagnosis and in endovascular and surgical treatments of both acute and chronic venous diseases have focused attention on several, previously clinically less important, details of venous anatomy. The time has come to standardize venous nomenclature so that general practitioners and specialists in the United States and abroad speak the same language. There is a need to adopt a universal terminology for the saphenous veins, to avoid the myriad of eponyms of perforators and, most importantly, to omit once and for all, the term “superficial” femoral vein when talking about a deep vein of the thigh. New anatomic names, such as the saphenous fascia and saphenous subcompartment, have to gain better recognition. To achieve the desired consensus on venous nomenclature, an international meeting was held in Rome, Italy, in 2001, under the auspices of the International Union of Phlebology. In this review on venous anatomy, we describe the most important previously published clinical recommendations from this conference, and suggest modifications based on their clinical experience using the new terminology.

Fibula osteofascial flap with proximal skin paddle for intraoral reconstruction

BACKGROUND

the fibula free flap has become a workhorse in intraoral reconstruction. However, its skin paddle has multiple drawbacks. The aim of this report is to establish the applicability of the fibula osteofascial flap in intraoral reconstruction.

METHODS

prospectively maintained database was performed in 15 patients who underwent fibula osteofascial flap for intraoral reconstruction. Mandibular reconstruction was the main location (13 patients). Ten flaps were done following tumor resection, three due to osteoradionecrosis and two following mandible fracture/bone loss. A standard fibula flap dissection performing an anterior approach was done, adding a distal fascial flap isolated on the distal perforators (for intraoral reconstruction) and a proximal skin paddle (for external soft tissue reconstruction).

RESULTS

One flap was lost due to hypercoagulable state. Fourteen flaps survived with complete oral mucosalization, resembling physiological intraoral bone coverage by 7 weeks (range: 6-8 weeks). One patient presented with delayed donor-site wound healing. The mean follow-up was 14.4 months (range: 2-33 months). Thirteen patients (87%) were without tracheotomy at last follow-up, and 14 patients (93%) were taking at least some nutrition by mouth.

CONCLUSION

Fibula osteofascial flap can be safely used for intraoral reconstruction. This flap provides a stable, thin, and vascularized fascia over the fibula with minimal donor-site complications. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2016 Wiley Periodicals, Inc. Microsurgery 37:276-281, 2017.

Fibula osteo-adipofascial flap for mandibular and maxillary reconstruction

BACKGROUND

The fibula free flap is a reliable method for reconstructing composite head and neck defects. However, its skin paddle has drawbacks, including its thickness, hair-bearing surface, desquamation, difficulty insetting it into maxillary defects, and the potential need for skin-grafting the donor site. The fibula osteo-adipofascial flap (FOAFF) is a modification of the fibula flap that overcomes these problems.

METHODS

A retrospective study of 6 consecutive patients who underwent FOAFF reconstruction was evaluated for outcomes and complications.

RESULTS

The mean follow-up was 22.6 months. All flaps survived, with complete oral mucosalization by 7 weeks. Four patients had dental implants placed at the time of reconstruction. Two patients received radiation therapy. Aside from loss of the labial sulcus in anterior maxillary reconstructions, complications were negligible.

CONCLUSION

The FOAFF is useful for reconstructing defects requiring bone, soft tissue, and mucosal replacement without the disadvantages of the traditional fibula skin paddle.

Reproducible subcutaneous transplantation of cell sheets into recipient mice

Perfecting tissue engineering and cell sheet transplantation is an important step toward realizing regenerative medicine and is a growing area of research. Before being applied to clinical settings, it is important that these approaches are evaluated in vivo. Here we provide a detailed protocol for handling thin cell sheets, for a simple and highly reproducible subcutaneous transplantation of cell sheets into mice, and for the histological examination of regenerated tissues. Various aspects of transplants can be assessed, such as maintenance, differentiation and proliferation. An emphasis is placed on surgical precision and reproducibility. The resulting consistency between surgeries helps minimize artifacts from surgical variation and therefore enables researchers to not only observe and compare the interactions between host tissues but also to compare transplants among different host animals. A single transplantation can be carried out within ∼10 min.

A review of vascular injection techniques for the study of perforator flaps

BACKGROUND

With a new era of flap surgery, additional anatomical information is required. The relatively recent interest in musculocutaneous perforator flaps has once again sparked interest in the vascular anatomy of surgical flaps. There are a variety of anatomical techniques available to define the vascular anatomy of tissues of interest. In this article, the authors review vascular injection techniques available and describe the technique currently used in their laboratory.

METHODS

A comprehensive review of vascular injection techniques is summarized. Barium sulfate and lead oxide in particular are reviewed in detail.

RESULTS

This article reviews the historical development of vascular injection techniques, outlines current investigative methods, and expands on a radiopaque lead oxide and gelatin injection method that provides high-quality angiograms.

CONCLUSIONS

The standard method for the study of perforator flap is the lead oxide-gelatin technique. However, other methods can provide complementary information on vascular anatomy.

Bimodal distribution of the blood supply to lower abdominal fat: histological study of the microcirculation of the lower abdominal wall

Fat necrosis is a common postoperative complication in transverse rectus abdominis muscle flap breast reconstruction. A histological quantification of the blood supply to the lower abdominal fat was undertaken to define this problem further. One hundred eighty sections, 1.5 cm(2) in size, were studied from one half of the lower abdomen in 10 fresh cadavers. These represent three different depths of fat (superficial, middle, deep) and six different anatomic areas (upper, middle, and lower sectors of the medial and lateral parts of the hemiabdomen). The average diameter, number of blood vessels, and the total vascular area were measured in each section. The average diameter of the blood vessels was greater in the superficial compared with the mid fat layer (p = 0.02). The total vascular area was greater in the deep compared with the mid fat layer (p = 0.01) and the superficial fat layer (p = 0.05). The number of blood vessels was also significantly higher in the deep fat layer compared with the mid fat layer (p = 0.001) and the superficial fat layer (p = 0.01). The lower medial area of the lower anterior abdominal wall contained the largest number and average diameter of blood vessels whereas the mid lateral area contained the smallest number and average diameter; however, this did not reach significance (p = 0.1 and 0.2). The results of this study are in keeping with the bimodal vascular supply to the subcutaneous fat of the anterior abdominal wall. The deep and the superficial fat layers are supplied more richly with vessels with a larger diameter whereas the intermediate fat layer is supplied from the terminal branches of these vessels.

The vertically based deep fascia turnover flap of the leg: anatomic studies and clinical applications

Although fasciocutaneous turnover flaps are a simple and fast method for covering soft-tissue defects of the lower leg, many reconstructive surgeons have their doubts about them. They revolve around the lack of criteria for safely designing these random-pattern flaps and around the risk of donor site problems. A vertically based deep fascia turnover flap with a paratibial or parafibular pedicle is presented. Anatomic studies of 36 injected lower limbs showed the deep fascia to be supplied by a mean of 61 vessels. As musculofascial, septofascial, and periosteofascial branches, these contribute to a richly anastomosing vascular network within the deep fascia. Along the deep transverse septum at the medial tibial border, the anterior and posterior peroneal septa, and between the anterior tibial and extensor muscles, the fascia is supplied by segmental vessels in a clearly defined arrangement. Pedicled on these vessels, the deep fascia is a useful candidate tissue for transversely oriented turnover flaps. These are particularly well suited for covering pretibial or prefibular soft-tissue defects. Unlike adipofascial turnover flaps, the transversely oriented deep fascia turnover flap keeps its subcutaneous layer with its intact vascular plexus so that the overlying skin is adequately perfused even in patients with sizable flaps or an extremely thin skin. Clinical experience with the vertically based paratibial or parafibular deep fascia turnover flap in six patients confirmed its usefulness for covering small to medium-sized soft tissue defects of the lower leg.