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Singhal M, Sabapathy SR, Gupta D, Mahapatra AK, Chauhan S, Tiwari R, Venkatramani H, Kedia S, Saha S, Sahu SAA, Dash S, Sodhi M. First Successful Separation of Craniopagus Twins in India—Plastic Surgical Considerations. Indian J Plast Surg 2022; 55:36-44. [PMID: 35444747 PMCID: PMC9015846 DOI: 10.1055/s-0041-1740406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.
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Affiliation(s)
- Maneesh Singhal
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | | | - Deepak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Chauhan
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Raja Tiwari
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Hari Venkatramani
- Division of Plastic, Hand, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Shweta Kedia
- All India Institute of Medical Sciences, New Delhi, India
| | - Shivangi Saha
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | | | - Suvashis Dash
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Megha Sodhi
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
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Chung JH, Cheon JH, Kim MS, Min DJ, Yoon ES, Lee BI, Park SH, Kim DW. Effects of vasopressors on circulation in the porcine abdominal island flap model. J Plast Reconstr Aesthet Surg 2019; 72:1653-1660. [PMID: 31395456 DOI: 10.1016/j.bjps.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/14/2019] [Accepted: 06/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation. METHODS The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute). RESULTS Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001). CONCLUSION Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.
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Affiliation(s)
- Jae-Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Jeong-Hyun Cheon
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Min-Sook Kim
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Doo-Jae Min
- Department of Anesthesiology and Pain Medicine, Korean University Medical Center, Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Byung-Il Lee
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea
| | - Deok-Woo Kim
- Department of Plastic and Reconstructive Surgery, Korea University Medical Center, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea.
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Comparison of two different laser photobiomodulation protocols on the viability of random skin flap in rats. Lasers Med Sci 2018; 34:1041-1047. [PMID: 30565200 DOI: 10.1007/s10103-018-2694-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/22/2018] [Indexed: 01/20/2023]
Abstract
To identify the best low level laser photobiomodulation application site at the same irradiation time to increase the viability of the skin flap in rats. Eighteen male rats (Rattus norvegicus: var. Albinus, Rodentia Mammalia) were randomly distributed into three groups (n = 6). Group I (GI) was submitted to simulated laser photobiomodulation; group II (GII) was submitted to laser photobiomodulation at three points in the flap cranial base, and group III (GIII) was submitted to laser photobiomodulation at 12 points distributed along the flap. All groups were irradiated with an Indium, Galium, Aluminum, and Phosphorus diode laser (InGaAlP), 660 nm, with 50 mW power, irradiated for a total time of 240 s in continuous emission mode. The treatment started immediately after performing the cranial base random skin flap (10 × 4 cm2 dimension) and reapplied every 24 h, with a total of five applications. The animals were euthanized after the evaluation of the percentage of necrosis area, and the material was collected for histological analysis on the seventh postoperative day. GII animals presented a statistically significant decrease for the necrosis area when compared to the other groups, and a statistically significant increase in the quantification of collagen when compared to the control. We did not observe a statistical difference between the TGFβ and FGF expression in the different groups evaluated. The application of laser photobiomodulation at three points of the flap cranial base was more effective than at 12 points regarding the reduction of necrosis area.
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Saito I, Hasegawa T, Ueha T, Takeda D, Iwata E, Arimoto S, Sakakibara A, Akashi M, Sakakibara S, Sakai Y, Terashi H, Komori T. Effect of local application of transcutaneous carbon dioxide on survival of random-pattern skin flaps. J Plast Reconstr Aesthet Surg 2018; 71:1644-1651. [PMID: 30031765 DOI: 10.1016/j.bjps.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/11/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Skin flap procedures are widely used to reconstruct skin and soft tissue defects. Skin flap necrosis is a serious postoperative complication. Many researchers have introduced pharmacological agents to improve flap ischemia in experimental studies. However, outcomes of these studies remain controversial. We previously demonstrated that transcutaneous CO2 application improves hypoxia in fracture repair. In this study, we hypothesized that improving hypoxia by transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis. We investigated whether transcutaneous CO2 application can increase the survival of random-pattern skin flaps. MATERIALS AND METHODS Six-week-old male Sprague-Dawley rats were divided into two equal groups: the control group (n = 6) and CO2 group (n = 6). A random-pattern skin flap was constructed in these rats. Topical CO2 was applied using a hydrogel every day for 5 days in the CO2 group. The flap survival area was measured on postoperative days 1, 3, and 5. The vessel density and expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and hypoxia-inducible factor-1α (HIF-1α) were evaluated on postoperative day 5. RESULTS A statistically significant difference was found in the percentage of the flap survival area between the two groups on postoperative days 3 and 5 (p < 0.05). Furthermore, the expression of VEGF and bFGF was significantly higher and that of HIF-1α was significantly lower in the CO2 than in the control group (p < 0.05). CONCLUSIONS Transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis, thus increasing the survival of random-pattern skin flaps.
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Affiliation(s)
- Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Takeshi Ueha
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; NeoChemir Inc., Kobe, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Satomi Arimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Human and Autologous Adipose-derived Stromal Cells Increase Flap Survival in Rats Independently of Host Immune Response. Ann Plast Surg 2018; 80:181-187. [DOI: 10.1097/sap.0000000000001184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laboratory animal research published in plastic surgery journals in 2014 has extensive waste: A systematic review. J Plast Reconstr Aesthet Surg 2015; 68:1485-90. [PMID: 26150221 DOI: 10.1016/j.bjps.2015.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 01/31/2023]
Abstract
UNLABELLED Laboratory animal research must be designed in a manner that minimizes bias if it is to yield valid and reproducible results. In 2009, a survey that examined 271 animal studies found that 87% did not use randomization and 86% did not use blinding. This has been called "research waste" because it wasted time and resources. This systematic review measured the quantity of research waste in plastic surgery journals in 2014. METHOD The PRISMA-P protocol was used. SCOPUS and PubMed searches were done for all animal studies published in 2014 in Aesthetic Plast Surg, Aesthet Surg J, Ann Plast Surg, JPRAS, J Plast Surg Hand Surg and Plast Reconstr Surg. These were supplemented by manual searches of the 2014 issues not indexed. Articles were analyzed for descriptions of randomization, randomization methodology, allocation concealment, and blinding of the primary outcome assessment. Corresponding authors who mentioned randomization without elaborating were emailed for details. RESULTS 112 of 154 articles met the inclusion criteria. Only 24/112 (21.4%) had blinding of the primary outcome measure, 28/110 (25.5%) of articles that required randomization mentioned it. While 12/28 articles clearly described randomizing the intervention, only 4/28 described the method of randomization, and 2/28 mentioned allocation concealment. Only two authors responded and described the randomization methodology. CONCLUSION The quality of plastic surgery laboratory animal research published in 2014 was poor. Use of the National Centre for the Replacement Refinement & Reduction of Animals in Research's "Animal Research: Reporting In Vivo Experiments" (ARRIVE) Guidelines by authors, and enforcement of them by editors and reviewers could improve research quality and reduce waste.
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