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Hou P, Xue H, Chang S, Xie P, Chen Y, Wang Y, Miura D, Fan J, Liang J, Kitayama A, Fang F, Yuan H, Wu X, Zhang X, Wang J, Ding N, Zhang C, Sun X, Takashi E. Thermal preconditioning can reduce the incidence of intraoperatively acquired pressure injuries. J Therm Biol 2023; 115:103617. [PMID: 37352595 DOI: 10.1016/j.jtherbio.2023.103617] [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: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
Intraoperatively acquired pressure injuries (IAPIs) occur frequently among patients who undergo surgical procedures that last longer than 3 h. Several studies indicated that heat shock proteins (HSPs) play an important role in the protection of stress-induced damages in skin tissues. Hence, the aim of this study was to investigate the potential preventive effect of thermal preconditioning (TPC) on IAPIs in surgical patients and rats and to identify the differentially expressed HSP genes in response to the above treatment. TPC was performed on one group of hairless rats before the model of pressure injuries was established. Subsequently, the size of skin lesions was measured and the expression levels of mRNA and protein of HSPs of the pressured skin were detected by real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into the TPC group (n = 59) and the control group (n = 59), respectively. The temperature and pressure of sacral skin, as well as the incidence of pressure injury (PI) were detected and compared. In animal studies, TPC significantly reduced both the size and incidence of PI in rats on the second, third and fourth days post treatment. In addition, the expression levels of both mRNA and protein of HSP27 were increased in the TPC group, compared with the control group. Immunohistochemical staining showed that HSP27 was distributed in various types of dermal cells and increased in basal cells. In human studies, a significant reduction (75%) of IAPIs was observed among the patients in the TPC group. TPC can reduce the incidence of PI in rats and humans, and the upregulation of HSP27 may play an important role in this biological progress. Further studies are warranted to explore the molecular mechanism of the preventive effect in PI mediated by HSP27.
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Affiliation(s)
- Ping Hou
- Nagano College of Nursing, 399-4117, Nagano, Japan; School of Nursing and School of Public Health, Yangzhou University, 225000, Yangzhou, China
| | - Huiping Xue
- Nagano College of Nursing, 399-4117, Nagano, Japan; Emergency Intensive Care Unit, Affiliated Hospital of Nantong University, 226000, Nantong, China
| | - Shuwen Chang
- Nagano College of Nursing, 399-4117, Nagano, Japan; Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ping Xie
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China.
| | - Yajie Chen
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Yanwei Wang
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Daiji Miura
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Jianglin Fan
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Jingyan Liang
- Health Science Center, Yangzhou University, 225000, Yangzhou, China.
| | | | - Fang Fang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Haijuan Yuan
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaoling Wu
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaolin Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Jing Wang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ning Ding
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Can Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiuyun Sun
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - En Takashi
- Nagano College of Nursing, 399-4117, Nagano, Japan.
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Weinzierl A, Schmauss D, Brucato D, Harder Y. Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind? J Clin Med 2022; 11:jcm11113079. [PMID: 35683465 PMCID: PMC9181810 DOI: 10.3390/jcm11113079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 01/15/2023] Open
Abstract
Over the last years, prepectoral implant-based breast reconstruction has undergone a renaissance due to several technical advancements regarding mastectomy techniques and surgical approaches for the placement and soft tissue coverage of silicone implants. Initially abandoned due to the high incidence of complications, such as capsular contraction, implant extrusion, and poor aesthetic outcome, the effective prevention of these types of complications led to the prepectoral technique coming back in style for the ease of implant placement and the conservation of the pectoralis muscle function. Additional advantages such as a decrease of postoperative pain, animation deformity, and operative time contribute to the steady gain in popularity. This review aims to summarize the factors influencing the trend towards prepectoral implant-based breast reconstruction and to discuss the challenges and prospects related to this operative approach.
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Affiliation(s)
- Andrea Weinzierl
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Germany;
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniel Schmauss
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (D.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Davide Brucato
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (D.B.)
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (D.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Correspondence:
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Avila FR, Torres-Guzman RA, Huayllani MT, Guliyeva G, Zubair AC, Quiñones-Hinojosa A, Forte AJ, Sarabia-Estrada R. Human stem cells prevent flap necrosis in preclinical animal models: A systematic review. J Clin Transl Res 2022; 8:110-124. [PMID: 35382131 PMCID: PMC8977210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 10/27/2022] Open
Abstract
Background and Aim Adipose-derived mesenchymal stem cells (ADSCs) have been proven effective to prevent distal skin flap necrosis in preclinical models. However, to appropriately translate these findings to clinical trials, the effect of ADSC of human origin (hADSC) needs to be evaluated. We hypothesize that hADSC treatment is as effective as animal ADSC treatment at preventing distal skin flap necrosis in animal flap models. Methods Three databases were inquired on August 17, 2020, to evaluate the necrotic flap area after using hADSCs in animal models of ischemic flaps. No publication status or dates were considered. Studies were included if they used hADSCs, measured the surviving or necrotic skin area of flaps, used animal models, and were in English. Studies were excluded if they did not use cells of human origin. The flap survival or necrotic area, perfusion, capillary density, vascular endothelial growth factor secretion and HIF-1α expression were extracted. Results Ten studies met inclusion criteria. The mean absolute risk reduction (ARR) in necrotic skin area was 22.37% (95% confidence interval [CI] 16.98-27.76%, P<0.05) for flaps treated with animal ADSCs and 18.04% (95% CI 2.74-33.33%, P<0.05) for flaps treated with hADSCs. The difference between mean ARRs was not statistically significant (4.33%, 95% CI - 34.47-43.13%, P>0.05). Conclusion Human ADSCs prevent skin flap necrosis to the same degree as animal ADSCs in rodent and rabbit flap models. Relevance for Patients This review found that adipose-derived stem cells of human origin are equally effective at reducing the risk of surgical flap necrosis in preclinical models of small animals as autologous animal cells. The findings in this review should encourage researchers to use human adipose-derived stem cells in animal models of ischemic flaps to accelerate their translation into clinical trials and, eventually, surgical practice. The low immunogenicity of these cells should be leveraged to gain insight into the effects of the products that will be ultimately administered to patients. Furthermore, human adipose-derived stem cells' pro-angiogenic mechanism of action sets this therapy as a promising preventive measure for flap necrosis.
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Affiliation(s)
- Francisco R. Avila
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | | | - María T. Huayllani
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Gunel Guliyeva
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Abba C. Zubair
- 2Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Antonio J. Forte
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States,3Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States,Corresponding author: Antonio J. Forte Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, Florida 32224, United States Tel: 904-953-2073
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Kankam HKN, Mehta S, Jain A. Thermal Preconditioning for Surgery: A Systematic Review. J Plast Reconstr Aesthet Surg 2020; 73:1645-1664. [PMID: 32505626 DOI: 10.1016/j.bjps.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/07/2020] [Accepted: 05/09/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Optimising patients pre-operatively reduces the chance of complications. This may be achieved by preconditioning. Thermal preconditioning refers to the supraphysiological heating of organisms or specific organs prior to an environmental insult. This review explores the current application and efficacy of thermal preconditioning for surgery. METHODS A comprehensive search of Medline (via PubMed), Embase and the Cochrane library was performed. Only articles evaluating the use of supraphysiological heating prior to a surgical intervention were included. Qualitative syntheses of data were undertaken due to the heterogeneity of the studies. The quality of each article was appraised using risk of bias tools (Cochrane and SYRCLE). RESULTS The primary literature search returned 3175 articles. After screening and reviewing reference lists, 28 papers met the inclusion criteria. The majority of studies were performed in animals, with only three clinical trials. Although there was broad coverage of different surgical techniques, flap transfer was the most commonly performed procedure. Most studies demonstrated a beneficial effect of thermal preconditioning, ranging from increased joint mobility to improved flap or organ transplant survival rates. The quality of evidence was variable, with experimental animal studies limited by a lack of methodological detail. CONCLUSIONS Thermal preconditioning for surgery has been primarily investigated using animal models. A beneficial effect has been demonstrated in most cases, across specialties ranging from plastic to general surgery. Future studies should aim to assess the clinical significance through large multicentre randomised controlled trials.
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Affiliation(s)
- Hadyn K N Kankam
- Department of Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Saahil Mehta
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Plastic Surgery, Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Abhilash Jain
- Department of Plastic and Reconstructive Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre Institute of Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
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