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Rogoń I, Rogoń A, Kaczmarek M, Bujnowski A, Wtorek J, Lachowski F, Jankau J. Flap Monitoring Techniques: A Review. J Clin Med 2024; 13:5467. [PMID: 39336953 PMCID: PMC11432309 DOI: 10.3390/jcm13185467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/31/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Postoperative tissue flap vitality monitoring enables early detection of clinical complications, allowing for intervention. Timely re-operation can prevent the need for extensive correction procedures, thus reducing healthcare costs and hospitalization time. Statistics show that monitoring can increase the success rate of flap survival to 95% or higher. However, despite the significant progress in monitoring techniques, major and minor complications, leading to the loss of the flap, still occur. This clinical application review aims to provide a comprehensive overview of the recent advancements and findings in flap surgery reconstructions, transplants, and systems for their postoperative assessment. The literature from the years 1925 to 2024 has been reviewed to capture previous and current solutions for monitoring flap vitality. Clinically acclaimed methods and experimental techniques were classified and reviewed from a technical and clinical standpoint. Physical examination, metabolism change, ultrasound method, and electromagnetic (EM) radiation-based measurement methods were carefully evaluated from the perspective of their considered applications. Guidelines aiding engineers in the future design and development process of monitoring systems were proposed. This paper provides a comprehensive overview of the monitoring techniques used in postoperative flap vitality monitoring. It also gives an overview of each approach and potential ways for future development.
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Affiliation(s)
- Ignacy Rogoń
- Biomedical Engineering Department, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 80-233 Gdansk, Poland; (M.K.); (A.B.); (J.W.)
| | | | - Mariusz Kaczmarek
- Biomedical Engineering Department, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 80-233 Gdansk, Poland; (M.K.); (A.B.); (J.W.)
| | - Adam Bujnowski
- Biomedical Engineering Department, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 80-233 Gdansk, Poland; (M.K.); (A.B.); (J.W.)
| | - Jerzy Wtorek
- Biomedical Engineering Department, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 80-233 Gdansk, Poland; (M.K.); (A.B.); (J.W.)
- BioTechMed Center, Gdansk University of Technology, 80-233 Gdansk, Poland
| | - Filip Lachowski
- Plastic Surgery Division, Medical Univeristy of Gdansk, 80-210 Gdansk, Poland; (F.L.); (J.J.)
| | - Jerzy Jankau
- Plastic Surgery Division, Medical Univeristy of Gdansk, 80-210 Gdansk, Poland; (F.L.); (J.J.)
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Rocans RP, Zarins J, Bine E, Mahauri I, Deksnis R, Citovica M, Donina S, Vanags I, Gravelsina S, Vilmane A, Rasa-Dzelzkaleja S, Mamaja B. Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery. J Clin Med 2024; 13:5411. [PMID: 39336896 PMCID: PMC11432012 DOI: 10.3390/jcm13185411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap complications and explore the relationship between chronic inflammation and VWF:Ag. Methods: This prospective cohort study included 88 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws were collected on the day of surgery before initiation of crystalloids. The plasma concentration of VWF:Ag as well as albumin, neutrophil-to-lymphocyte ratio (NLR), interleukin-6, and fibrinogen were determined. Results: The overall complication rate was 27.3%, and true flap loss occurred in 11.4%. VWF:Ag levels were higher in true flap loss when compared to patients without complications (217.94 IU/dL [137.27-298.45] vs. 114.14 [95.67-132.71], p = 0.001). Regression analysis revealed the association between VWF:Ag and true flap loss at the cutoff of 163.73 IU/dL (OR 70.22 [10.74-485.28], p = 0.043). Increased VWF:Ag concentrations were linked to increases in plasma fibrinogen (p < 0.001), C-reactive protein (p < 0.001), interleukin-6 (p = 0.032), and NLR (p = 0.019). Conclusions: Preoperative plasma VWF:Ag concentration is linked to biomarkers of inflammation and may be valuable in predicting complications in microvascular flap surgery.
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Affiliation(s)
- Rihards Peteris Rocans
- Intensive Care Clinic, Riga East University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia;
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia; (I.M.); (I.V.); (B.M.)
| | - Janis Zarins
- Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Brivibas Street 410, LV-1024 Riga, Latvia;
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Pulka Street 3, LV-1007 Riga, Latvia
| | - Evita Bine
- Intensive Care Clinic, Riga East University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia;
| | - Insana Mahauri
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia; (I.M.); (I.V.); (B.M.)
| | - Renars Deksnis
- Surgical Oncology Clinic, Riga East University Hospital, Hipokrata Street 4, LV-1079 Riga, Latvia;
| | - Margarita Citovica
- Laboratory Department, Riga East University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia;
| | - Simona Donina
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Street 5, LV-1067 Riga, Latvia; (S.D.); (S.G.); (A.V.); (S.R.-D.)
- Outpatient Department, Riga East University Hospital, Hipokrata Street 4, LV-1079 Riga, Latvia
| | - Indulis Vanags
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia; (I.M.); (I.V.); (B.M.)
| | - Sabine Gravelsina
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Street 5, LV-1067 Riga, Latvia; (S.D.); (S.G.); (A.V.); (S.R.-D.)
| | - Anda Vilmane
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Street 5, LV-1067 Riga, Latvia; (S.D.); (S.G.); (A.V.); (S.R.-D.)
| | - Santa Rasa-Dzelzkaleja
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Street 5, LV-1067 Riga, Latvia; (S.D.); (S.G.); (A.V.); (S.R.-D.)
| | - Biruta Mamaja
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia; (I.M.); (I.V.); (B.M.)
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Yin J, Wang L, Wang Z, Shi Y, Xiong P, He Y, Qin X. Gender Disparities and Ultrasonographic Evaluation of Anatomic Features of Anterolateral Thigh Flap (ALT) in Individuals with Diverse BMI: A Retrospective Clinical Study. JPRAS Open 2024; 41:420-427. [PMID: 39262614 PMCID: PMC11387518 DOI: 10.1016/j.jpra.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 09/13/2024] Open
Abstract
Background The anterolateral thigh (ALT) flap plays a crucial role in reconstructive surgeries, providing versatile and reliable soft-tissue coverage. Flap thickness is a critical determinant of tissue volume and quality. Vascular factors, including the vascular diameter of the perforators and the length of the vascular pedicle, significantly influence flap viability and postrepair outcomes. To enhance preoperative assessment, this study integrated gender and body mass index (BMI) to analyze the anatomical characteristics of ALT flaps. Methods This study used somatic penetrating ultrasonography to examine bilateral ALT flaps in patients. This study analyzed the relationship between gender and ALT flap thickness, vascular diameter of the perforators, and vascular pedicle length. Chi-square test was used to assess variations in age and gender. Multiple t-tests compared flap thickness, vascular diameter, and pedicle length between men and women in different BMI groups. Results A total of 158 patients were included in this study from January 2018 to December 2022. In BMI < 24 and BMI ≥ 24.0 groups, males had lower ALT flap thickness than females (p < 0.0001 in each subgroup). Similarly, the vascular diameter of the perforators followed the same trend, with females having larger vascular diameters than males in BMI < 24 and BMI ≥ 24.0 groups. In terms of vascular pedicle length, males had longer pedicle length than females in both BMI < 24 and BMI ≥ 24.0 groups (p < 0.05 in each subgroup). Conclusions Females demonstrate greater ALT flap thickness and larger vascular diameter of the perforators than males, whereas males have a longer length of the vascular pedicle.
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Affiliation(s)
- Jianxin Yin
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 200011, Shanghai, China
| | - Lei Wang
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, 14195, Berlin, Germany
| | - Zhouyang Wang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Yanni Shi
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 200011, Shanghai, China
| | - Yue He
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
| | - Xingjun Qin
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. 200011, Shanghai, China
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Lan Q, Wang K, Meng Z, Lin H, Zhou T, Lin Y, Jiang Z, Chen J, Liu X, Lin Y, Lin D. Roxadustat promotes hypoxia-inducible factor-1α/vascular endothelial growth factor signalling to enhance random skin flap survival in rats. Int Wound J 2023; 20:3586-3598. [PMID: 37225176 PMCID: PMC10588316 DOI: 10.1111/iwj.14235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
Random skin flaps have limited clinical application as a broad surgical reconstruction treatment because of distal necrosis. The prolyl hydroxylase domain-containing protein inhibitor roxadustat (RXD) enhances angiogenesis and reduces oxidative stress and inflammation. This study explored the function of RXD in the survival of random skin flaps. Thirty-six male Sprague-Dawley rats were randomly divided into low-dose RXD group (L-RXD group, 10 mg/kg/2 day), high-dose RXD group (H-RXD group, 25 mg/kg/2 day), and control group (1 mL of solvent, 1:9 DMSO:corn oil). The proportion of surviving flaps was determined on day 7 after surgery. Angiogenesis was assessed by lead oxide/gelatin angiography, and microcirculation blood perfusion was evaluated by laser Doppler flow imaging. Specimens in zone II were obtained, and the contents of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured as indicators of oxidative stress. Histopathological status was evaluated with haematoxylin and eosin staining. The levels of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and the inflammatory factors interleukin (IL)-1β, IL-6, and tumour necrosis factor-α (TNF-α) were detected by immunohistochemistry. RXD promoted flap survival and microcirculatory blood perfusion. Angiogenesis was detected distinctly in the experimental group. SOD activity increased and the MDA level decreased in the experimental group. Immunohistochemistry indicated that the expression levels of HIF-1α and VEGF were increased while the levels of IL-6, IL-1β, and TNF-α were decreased after RXD injection. RXD promoted random flap survival by reinforcing vascular hyperplasia and decreasing inflammation and ischaemia-reperfusion injury.
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Affiliation(s)
- Qicheng Lan
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical University, The First School of Clinical Medical, Wenzhou Medical UniversityWenzhouChina
| | - Kaitao Wang
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Zhefeng Meng
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Hang Lin
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical University, The First School of Clinical Medical, Wenzhou Medical UniversityWenzhouChina
| | - Taotao Zhou
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Yi Lin
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Zhikai Jiang
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Jianpeng Chen
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Xuao Liu
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
| | - Yuting Lin
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical University, The First School of Clinical Medical, Wenzhou Medical UniversityWenzhouChina
| | - Dingsheng Lin
- Department of Hand and Plastic SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical UniversityWenzhouChina
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The Role of von Willebrand Factor in Microvascular Surgery in Severely Injured Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3836. [PMID: 34616639 PMCID: PMC8489897 DOI: 10.1097/gox.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022]
Abstract
Microvascular anastomosis has become a standard surgical technique for reconstruction because of increasing possibilities, indications, and clinical success regarding the survival of the flaps. However, the main dreaded complications exist in thrombosis. Leaving surgical complications aside, systemic problems like disorder of the coagulation-fibrinolysis system are a significant cause of graft loss usually being unrecognized. Reports exist describing a hypercoagulable state with clotting activation and inhibition of fibrinolysis after trauma and delayed surgery considering the secondary homeostasis. In this clinical case, a patient had a large soft tissue defect at the temporal side of the head after severe trauma. After some days of primary stabilization, reconstruction using a free microvascular latissimus dorsi flap was performed. Multiple revisions of the arterial and venous branches had to be performed intraoperatively due to insufficient flap perfusion. After 24 hours, definitive flap loss occurred due to multiple thrombosis in the arterial and venous branches. Postoperative comprehensive coagulation analysis revealed a distinct activation of primary hemostasis with massively increased von Willebrand factor parameters and factor VIII activity as well as acetylsalicylic acid resistance contributing to thrombotic occlusion. In severely injured patients, comprehensive preoperative determination of the coagulation status (especially those of the primary hemostasis) is indispensable before performing free flap reconstruction surgeries to reduce the risk of microvascular flap loss.
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Macrophage Migration Inhibitory Factor-An Innovative Indicator for Free Flap Ischemia after Microsurgical Reconstruction. Healthcare (Basel) 2021; 9:healthcare9060616. [PMID: 34063809 PMCID: PMC8223971 DOI: 10.3390/healthcare9060616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Nowadays, the use of microsurgical free flaps is a standard operative procedure in reconstructive surgery. Still, thrombosis of the microanastomosis is one of the most fatal postoperative complications. Clinical evaluation, different technical devices and laboratory markers are used to monitor critical flap perfusion. Macrophage migration inhibitory factor (MIF), a structurally unique cytokine with chemokine-like characteristics, could play a role in predicting vascular problems and the failure of flap perfusion. (2) Methods: In this prospective observational study, 26 subjects that underwent microsurgical reconstruction were observed. Besides clinical data, the number of blood leukocytes, CRP and MIF were monitored. (3) Results: Blood levels of MIF, C-reactive protein (CRP) and leukocytes increased directly after surgery. Subjects that needed surgical revision due to thrombosis of the microanastomosis showed significantly higher blood levels of MIF than subjects without revision. (4) Conclusion: We conclude that MIF is a potential and innovative indicator for thrombosis of the microanastomosis after free flap surgery. Since it is easy to obtain diagnostically, MIF could be an additional tool to monitor flap perfusion besides clinical and technical assessments.
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Hacker S, Mittermayr R, Traxler D, Keibl C, Resch A, Salminger S, Leiss H, Hacker P, Gabriel C, Golabi B, Pauzenberger R, Slezak P, Laggner M, Mildner M, Michlits W, Ankersmit HJ. The secretome of stressed peripheral blood mononuclear cells increases tissue survival in a rodent epigastric flap model. Bioeng Transl Med 2021; 6:e10186. [PMID: 33532586 PMCID: PMC7823127 DOI: 10.1002/btm2.10186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022] Open
Abstract
Reconstructive surgery transfers viable tissue to cover defects and to restore aesthetic and functional properties. Failure rates after free flap surgery range from 3 to 7%. Co-morbidities such as diabetes mellitus or peripheral vascular disease increase the risk of flap failure up to 4.5-fold. Experimental therapeutic concepts commonly use a monocausal approach by applying single growth factors. The secretome of γ-irradiated, stressed peripheral blood mononuclear cells (PBMCsec) resembles the physiological environment necessary for tissue regeneration. Its application led to improved wound healing rates and a two-fold increase in blood vessel counts in previous animal models. We hypothesized that PBMCsec has beneficial effects on the survival of compromised flap tissue by reducing the necrosis rate and increasing angiogenesis. Surgery was performed on 39 male Sprague-Dawley rats (control, N = 13; fibrin sealant, N = 14; PBMCsec, N = 12). PBMCsec was produced according to good manufacturing practices (GMP) guidelines and 2 ml were administered intraoperatively at a concentration of 2.5 × 107 cells/ml using fibrin sealant as carrier substance. Flap perfusion and necrosis (as percentage of the total flap area) were analyzed using Laser Doppler Imaging and digital image planimetry on postoperative days 3 and 7. Immunohistochemical stainings for von Willebrand factor (vWF) and Vascular Endothelial Growth Factor-receptor-3 (Flt-4) were performed on postoperative day 7 to evaluate formation of blood vessels and lymphatic vessels. Seroma formation was quantified using a syringe and flap adhesion and tissue edema were evaluated clinically through a cranial incision by a blinded observer according to previously described criteria on postoperative day 7. We found a significantly reduced tissue necrosis rate (control: 27.8% ± 8.6; fibrin: 22.0% ± 6.2; 20.9% reduction, p = .053 vs. control; PBMCsec: 19.1% ± 7.2; 31.1% reduction, p = .012 vs. control; 12.9% reduction, 0.293 vs. fibrin) together with increased vWF+ vessel counts (control: 70.3 ± 16.3 vessels/4 fields at 200× magnification; fibrin: 67.8 ± 12.1; 3.6% reduction, p = .651, vs. control; PBMCsec: 85.9 ± 20.4; 22.2% increase, p = .045 vs. control; 26.7% increase, p = .010 vs. fibrin) on postoperative day 7 after treatment with PBMCsec. Seroma formation was decreased after treatment with fibrin sealant with or without the addition of PBMCsec. (control: 11.9 ± 9.7 ml; fibrin: 1.7 ± 5.3, 86.0% reduction, 0.004 vs. control; PBMCsec: 0.6 ± 2.0; 94.8% reduction, p = .001 vs. control; 62.8% reduction, p = .523 vs. fibrin). We describe the beneficial effects of a secretome derived from γ-irradiated PBMCs on tissue survival, angiogenesis, and clinical parameters after flap surgery in a rodent epigastric flap model.
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Affiliation(s)
- Stefan Hacker
- Division of Plastic and Reconstructive SurgeryMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and RegenerationViennaAustria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
| | - Denise Traxler
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and RegenerationViennaAustria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
| | - Annika Resch
- Division of Plastic and Reconstructive SurgeryMedical University of ViennaViennaAustria
| | - Stefan Salminger
- Division of Plastic and Reconstructive SurgeryMedical University of ViennaViennaAustria
| | - Harald Leiss
- Division of RheumatologyMedical University of ViennaViennaAustria
| | - Philipp Hacker
- Department of Oral‐ and Maxillofacial SurgeryUniversity Clinic Sankt PoeltenSankt PoeltenAustria
| | - Christian Gabriel
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazAustria
| | - Bahar Golabi
- Department of DermatologyMedical University of ViennaViennaAustria
| | - Reinhard Pauzenberger
- Division of Plastic and Reconstructive SurgeryMedical University of ViennaViennaAustria
| | - Paul Slezak
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
| | - Maria Laggner
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and RegenerationViennaAustria
| | - Michael Mildner
- Department of DermatologyMedical University of ViennaViennaAustria
| | - Wolfgang Michlits
- Department of Plastic and Reconstructive SurgeryHospital Wiener NeustadtWiener NeustadtAustria
| | - Hendrik J. Ankersmit
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and RegenerationViennaAustria
- Division of Thoracic SurgeryMedical University of ViennaViennaAustria
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Fang M, He J, Ma X, Li W, Lin D. Protective effects of dexmedetomidine on the survival of random flaps. Biomed Pharmacother 2020; 128:110261. [PMID: 32446114 DOI: 10.1016/j.biopha.2020.110261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Random flaps can be used to repair wounds and improve shape and functional reconstruction, but inflammation and necrosis limit their application. Modified McFarlane flap models were constructed on the backs of rats. We hypothesized that dexmedetomidine (DEX) could improve the survival rate of ischemic random flaps. METHODS Sixty rats were randomly divided into three groups: a low-dose DEX group (DEX-L group, 10 μg/kg/D), a high-dose DEX group (DEX-H group, 20 μg/kg/D) and a control group (0.9 % saline equivalent). On day 7 after flap construction, the survival percentage of the flap model was calculated. Hematoxylin and eosin staining (H&E) was used to evaluate the histopathological status of the flaps and microvessel density (MVD). Lead oxide/gelatin angiography was used to detect angiogenesis, and laser Doppler flow imaging (LDF) was used to detect blood perfusion. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in the middle areas of the flaps were measured to show the level of oxidative stress. The expressions of Toll-like receptor (TLR4), nuclear factor-kappa B (NF-κB), interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry. RESULTS DEX significantly increased the average survival percentage of the flaps and reduced ischemia and necrosis of the distal end of the flaps. SOD activity significantly increased, while MDA significantly decreased, indicating that DEX reduces oxidative damage. The expression of inflammatory immunoregulatory proteins (TLR4, NF-κB) was downregulated, and the levels of inflammatory factors (IL-1β, IL-6 and TNF-α) were lower. In addition, DEX upregulated VEGF expression, promoted angiogenesis, and increased blood perfusion. CONCLUSION In random flap transplantation, a high dose of DEX is beneficial to flap survival.
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Affiliation(s)
- Miaojie Fang
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jibing He
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xinyi Ma
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Wenjie Li
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Dingsheng Lin
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
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Qing L, Wu P, Zhou Z, Yu F, Tang J. Tetramethylpyrazine improved the survival of multiterritory perforator flaps by inducing angiogenesis and suppressing apoptosis via the Akt/Nrf2 pathway. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1437-1447. [PMID: 31118578 PMCID: PMC6504674 DOI: 10.2147/dddt.s195090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/06/2019] [Indexed: 12/15/2022]
Abstract
Background: Multiterritory perforator flaps were commonly designed to cover the large soft-tissue defects in reconstructive surgery. But the high risk of partial necrosis in the distal portion of the flaps hindered their clinical application. The purpose of this study was to evaluate the effects of tetramethylpyrazine (TMP) on the survival of the multiterritory perforator flaps and to explore the underlying mechanism. Materials and methods: Seventy-two Sprague–Dawley rats underwent multiterritory perforator flap procedure and were divided into three groups with 24 each. Flap survival and water content were measured, and the area of angiogenesis and apoptosis in the ischemia skin flaps were assessed on the postoperative day 7. The expressions of angiogenesis-related protein VEGF and apoptosis-related protein Bax, Bcl-2 in each group were detected by Western blotting, which also had been used to assess the expressions levels of Akt, p-Akt, and Nrf2. Results: Following TMP treatment, the survival area and number of microvessels presented in the skin flaps increased and tissue edema reduced on postoperative day 7. The expressions of angiogenesis-related protein VEGF increased in the TMP treatment group than in the control group. In addition, compared with the control group, TMP inhibited apoptosis, and increased the expression levels of p-Akt, Nrf2 in the areas of ischemia. These effects were reversed by an Akt protein inhibitor LY294002. Similarly, treatment with LY294002 inhibited TMP induced by interfering the Akt/Nrf2 signaling pathway. Conclusion: These results illustrated that TMP could promote the survival of multiterritory perforator flaps by enhancing angiogenesis and attenuating apoptosis. These were involved in Akt/Nrf2 signaling pathway.
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Affiliation(s)
- LiMing Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Neurosurgery, Maryland University of Medicine School- Baltimore, Baltimore, MD, USA
| | - PanFeng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - ZhengBing Zhou
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Fang Yu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - JuYu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap. Plast Reconstr Surg 2019; 143:322e-328e. [PMID: 30688892 PMCID: PMC6358195 DOI: 10.1097/prs.0000000000005256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap. Methods: Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed. Results: The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05). Conclusion: Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.
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Wu K, Lei JS, Mao YY, Cao W, Wu HJ, Ren ZH. Prediction of Flap Compromise by Preoperative Coagulation Parameters in Head and Neck Cancer Patients. J Oral Maxillofac Surg 2018; 76:2453.e1-2453.e7. [PMID: 30076809 DOI: 10.1016/j.joms.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Studies on coagulation parameters (including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen [FIB], platelet count, and D-dimer) in flap compromise are limited. The aim of the present study was to compare coagulation parameter variables in patients with and without flap compromise. MATERIALS AND METHODS In this retrospective cohort study, patients were recruited from the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital (Changsha, Hunan, China) from July 2016 through July 2017. The primary predictor variable was a set of coagulation parameters. The primary outcome variable was flap compromise. The other variables were age, gender, tumor stage, smoking, and prior radiotherapy. Descriptive, bivariate, receiver operating characteristic (ROC) curves and regression statistics were computed. Statistical significance was set at less than .05 with 95% reliability. RESULTS A total of 503 patients with 42 compromised flaps were identified in this study. Venous thrombosis, arterial thrombosis, or no confirmed reason for compromise was observed in 28, 5, or 9 compromised flaps, respectively. Only FIB was associated with flap compromise or venous thrombosis at adjusted analyses, although the predictive values were low at ROC analysis. For patients with D-dimer lower than 0.4 μg/mL, the likelihood of venous thrombosis was greater than that for patients with D-dimer of at least 0.4 μg/mL (P = .0414). For patients with FIB lower than 3.5 g/L, the likelihood of venous thrombosis was greater than that for patients with FIB of at least 3.5 g/L (P = .0336). CONCLUSION Decreased FIB was associated with a higher rate of flap compromise. In patients with D-dimer lower than 0.4 μg/mL or FIB lower than 3.5 g/L, the risk of venous thrombosis was higher.
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Affiliation(s)
- Kun Wu
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Shi Lei
- Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuan-Yuan Mao
- Resident, Department of Anesthesiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wei Cao
- Associate Professor, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Jiang Wu
- Department Head, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen-Hu Ren
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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