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Orizondo RA, Bengur FB, Komatsu C, Strong KR, Federspiel WJ, Solari MG. Machine Perfusion Deters Ischemia-Related Derangement of a Rodent Free Flap: Development of a Model. J Surg Res 2024; 295:203-213. [PMID: 38035871 DOI: 10.1016/j.jss.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Machine perfusion can enable isolated support of composite tissues, such as free flaps. The goal of perfusion in this setting is to preserve tissues prior to transplantation or provide transient support at the wound bed. This study aimed to establish a rodent model of machine perfusion in a fasciocutaneous-free flap to serve as an affordable testbed and determine the potential of the developed support protocol to deter ischemia-related metabolic derangement. METHODS Rat epigastric-free flaps were harvested and transferred to a closed circuit that provides circulatory and respiratory support. Whole rat blood was recirculated for 8 h, while adjusting the flow rate to maintain arterial-like perfusion pressures. Blood samples were collected during support. Extracellular tissue lactate and glucose levels were characterized with a microdialysis probe and compared with warm ischemic, cold ischemic, and anastomosed-free flap controls. RESULTS Maintenance of physiologic arterial pressures (85-100 mmHg) resulted in average pump flow rates of 360-430 μL/min. Blood-based measurements showed maintained glucose and oxygen consumption throughout machine perfusion. Average normalized lactate to glucose ratio for the perfused flaps was 5-32-fold lower than that for the warm ischemic flap controls during hours 2-8 (P < 0.05). CONCLUSIONS We developed a rat model of ex vivo machine perfusion of a fasciocutaneous-free flap with maintained stable flow and tissue metabolic activity for 8 h. This model can be used to assess critical elements of support in this setting as well as explore other novel therapies and technologies to improve free tissue transfer.
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Affiliation(s)
- Ryan A Orizondo
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chiaki Komatsu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly R Strong
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William J Federspiel
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Clinical and Translational Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Aksamitiene E, Heffelfinger RN, Hoek JB, Pribitkin ED. Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing. Biol Proced Online 2024; 26:2. [PMID: 38229030 DOI: 10.1186/s12575-023-00227-w] [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: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Some of the most complex surgical interventions to treat trauma and cancer include the use of locoregional pedicled and free autologous tissue transfer flaps. While the techniques used for these reconstructive surgery procedures have improved over time, flap complications and even failure remain a significant clinical challenge. Animal models are useful in studying the pathophysiology of ischemic flaps, but when repeatability is a primary focus of a study, conventional in-vivo designs, where one randomized subset of animals serves as a treatment group while a second subset serves as a control, are at a disadvantage instigated by greater subject-to-subject variability. Our goal was to provide a step-by-step methodological protocol for creating an alternative standardized, more economical, and transferable pre-clinical animal research model of excisional full-thickness wound healing following a simulated autologous tissue transfer which includes the primary ischemia, reperfusion, and secondary ischemia events with the latter mimicking flap salvage procedure. RESULTS Unlike in the most frequently used classical unilateral McFarlane's caudally based dorsal random pattern skin flap model, in the herein described bilateral epigastric fasciocutaneous advancement flap (BEFAF) model, one flap heals under normal and a contralateral flap-under perturbed conditions or both flaps heal under conditions that vary by one within-subjects factor. We discuss the advantages and limitations of the proposed experimental approach and, as a part of model validation, provide the examples of its use in laboratory rat (Rattus norvegicus) axial pattern flap healing studies. CONCLUSIONS This technically challenging but feasible reconstructive surgery model eliminates inter-subject variability, while concomitantly minimizing the number of animals needed to achieve adequate statistical power. BEFAFs may be used to investigate the spatiotemporal cellular and molecular responses to complex tissue injury, interventions simulating clinically relevant flap complications (e.g., vascular thrombosis) as well as prophylactic, therapeutic or surgical treatment (e.g., flap delay) strategies in the presence or absence of confounding risk factors (e.g., substance abuse, irradiation, diabetes) or favorable wound-healing promoting activities (e.g., exercise). Detailed visual instructions in BEFAF protocol may serve as an aid for teaching medical or academic researchers basic vascular microsurgery techniques that focus on precision, tremor management and magnification.
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Affiliation(s)
- Edita Aksamitiene
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
- Present address: Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, 405 N. Mathews Ave | M/C 251, Room 4357, Urbana, IL, 61801, USA
| | - Ryan N Heffelfinger
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
| | - Jan B Hoek
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 1020 Locust St, Room 527, Philadelphia, PA, 19107, USA
| | - Edmund deAzevedo Pribitkin
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA.
- Sidney Kimmel Medical College, 31st Floor, 1101 Market Street, Philadelphia, PA, 19107, USA.
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Cao Z, Li C, He J, Sui X, Wu P, Pan D, Qing L, Tang J. FK506-loaded PLGA nanoparticles improve long-term survival of a vascularized composite allograft in a murine model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1515. [PMID: 34790721 PMCID: PMC8576731 DOI: 10.21037/atm-21-2425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
Background The side effects of life-long administration of FK506 limit the clinical practice of vascularized composite allografts (VCAs). This study aimed to evaluate the feasibility of FK506-loaded poly (lactic-co-glycolic acid) (PLGA) nanoparticles (FK506 NPs) for prolonging the long-term survival of VCAs and reducing the side effects of FK506. Methods PLGA nanoparticles loaded with FK506 were prepared by the solvent evaporation method. The characterization of FK506 NPs was evaluated by electron microscopy. To confirm the function and safety of FK506 NPs, these particles were administrated into rats by intraperitoneal injection. The survival time of the allograft, systemic concentration of FK506, anti-rejection activity, and side-effect of FK506 NPs were evaluated in a Brown Norway (BN)-to-Sprague Dawley (SD) epigastric VCA transplantation model. Results Compared with the nontreatment, PLGA control and FK506 groups, the median survival times (MST) of the FK506 NP groups were significantly prolonged. The FK506 NPs could maintain therapeutic drug concentration for 60 days. Moreover, cytokine concentrations, flow cytometry of regulatory T cells (Tregs) and histopathology of allografts revealed significantly prolonged immunosuppression by FK506 NPs. FK506 NPs also ameliorated FK506 nephrotoxicity. Conclusions FK506 NPs prolong the survival time of VCAs in a murine model with minimal nephrotoxicity, and provide a potential clinical strategy for ameliorating long-term side effects of immunosuppressive therapy.
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Affiliation(s)
- Zheming Cao
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Cheng Li
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Jiqiang He
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Xinlei Sui
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Ding Pan
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Liming Qing
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, China
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A cutaneous mechanoneural interface for neuroprosthetic feedback. Nat Biomed Eng 2021; 6:731-740. [PMID: 33526908 DOI: 10.1038/s41551-020-00669-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/26/2020] [Indexed: 01/16/2023]
Abstract
Amputation destroys sensory end organs and does not provide an anatomical interface for cutaneous neuroprosthetic feedback. Here, we report the design and a biomechanical and electrophysiological evaluation of the cutaneous mechanoneural interface consisting of an afferent neural system that comprises a muscle actuator coupled to a natively pedicled skin flap in a cuff-like architecture. Muscle is actuated through electrical stimulation to induce strains or oscillatory vibrations on the skin flap that are proportional to a desired contact duration or contact pressure. In rat hindlimbs, the mechanoneural interface elicited native dermal mechanotransducers to generate at least four levels of graded contact and eight distinct vibratory afferents that were not significantly different from analogous mechanical stimulation of intact skin. The application of different patterns of electrical stimulation independently engaged slowly adapting and rapidly adapting mechanotransducers, and recreated an array of cutaneous sensations. The cutaneous mechanoneural interface can be integrated with current prosthetic technologies for tactile feedback.
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Won HR, Seo C, Lee HY, Roh J, Kim CH, Jang JY, Shin YS. An Important Role of Macrophages for Wound Margin Regeneration in a Murine Flap Model. Tissue Eng Regen Med 2019; 16:667-674. [PMID: 31824828 DOI: 10.1007/s13770-019-00214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Macrophages have been known to have diverse roles either after tissue damage or during the wound healing process; however, their roles in flap wound healing are poorly understood. In this study, we aimed to evaluate how macrophages contribute to the flap wound regeneration. Methods A murine model of a pedicled flap was generated, and the time-course of the wound healing process was determined. Especially, the interface between the flap and the residual tissue was histopathologically evaluated. Using clodronate liposome, a macrophage-depleting agent, the functional role of macrophages in flap wound healing was investigated. Coculture of human keratinocyte cell line HaCaT and monocytic cell line THP-1 was performed to unveil relationship between the two cell types. Results Macrophage depletion significantly impaired flap wound healing process showing increased necrotic area after clodronate liposome administration. Interestingly, microscopic evaluation revealed that epithelial remodeling between the flap tissue and residual normal tissue did not occurred under the lack of macrophage infiltration. Coculture and scratch wound healing assays indicated that macrophages significantly affected the migration of keratinocytes. Conclusion Macrophages play a critical role in the flap wound regeneration. Especially, epithelial remodeling at the flap margin is dependent on proper macrophage infiltration. These results implicate to support the cellular mechanisms of impaired flap wound healing.
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Affiliation(s)
- Ho-Ryun Won
- 1Department of Otorhinolaryngology - Head and Neck Surgery, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015 Republic of Korea
| | - Chorong Seo
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Hye-Young Lee
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Jin Roh
- 3Department of Pathology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Chul-Ho Kim
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
- 4Department of Molecular Science and Technology, Ajou University, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Jeon Yeob Jang
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Yoo Seob Shin
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
- 4Department of Molecular Science and Technology, Ajou University, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
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Casal D, Iria I, Ramalho JS, Alves S, Mota-Silva E, Mascarenhas-Lemos L, Pontinha C, Guadalupe-Cabral M, Ferreira-Silva J, Ferraz-Oliveira M, Vassilenko V, Goyri-O'Neill J, Pais D, Videira PA. BD-2 and BD-3 increase skin flap survival in a model of ischemia and Pseudomonas aeruginosa infection. Sci Rep 2019; 9:7854. [PMID: 31133641 PMCID: PMC6536547 DOI: 10.1038/s41598-019-44153-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/09/2019] [Indexed: 02/08/2023] Open
Abstract
The main aim of this work was to study the usefulness of human β-defensins 2 (BD-2) and 3 (BD-3), which are part of the innate immune system, in the treatment of infected ischemic skin flaps. We investigated the effect of transducing rat ischemic skin flaps with lentiviral vectors encoding human BD-2, BD-3, or both BD-2 and BD-3, to increase flap survival in the context of a P. aeruginosa infection associated with a foreign body. The secondary endpoints assessed were: bacterial counts, and biofilm formation on the surface of the foreign body. A local ischemic environment was created by producing arterialized venous flaps in the left epigastric region of rats. Flaps were intentionally infected by placing underneath them two catheters with 105 CFU of P. aeruginosa before the surgical wounds were hermetically closed. Flap biopsies were performed 3 and 7 days post-operatively, and the specimens submitted to immunohistochemical analysis for BD-2 and BD-3, as well as to bacterial quantification. Subsequently, the catheter segments were analyzed with scanning electron microscopy (SEM). Flaps transduced with BD-2 and BD-3 showed expression of these defensins and presented increased flap survival. Rats transduced with BD-3 presented a net reduction in the number of P. aeruginosa on the surface of the foreign body and lesser biofilm formation.
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Affiliation(s)
- Diogo Casal
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal.
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Lisbon, Caparica, Portugal.
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Inês Iria
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Lisbon, Caparica, Portugal
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- Molecular Microbiology and Biotechnology Unit, iMed, ULisboa, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- INESC MN - Microsystems and Nanotechnologies, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - José S Ramalho
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sara Alves
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal
| | - Eduarda Mota-Silva
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Caparica, Portugal
| | - Luís Mascarenhas-Lemos
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal
| | - Carlos Pontinha
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal
| | - Maria Guadalupe-Cabral
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - José Ferreira-Silva
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal
| | - Mário Ferraz-Oliveira
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José, Lisbon, Portugal
| | - Valentina Vassilenko
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Caparica, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pais
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paula A Videira
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Lisbon, Caparica, Portugal.
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal.
- CDG & Allies- Professional and Patient Association International Network (PPAIN), Lisbon, Caparica, Portugal.
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Unconventional Perfusion Flaps in the Experimental Setting: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 143:1003e-1016e. [PMID: 31033823 PMCID: PMC6493691 DOI: 10.1097/prs.0000000000005560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Unconventional perfusion flaps offer multiple potential advantages compared with traditional flaps. Although there are numerous experimental articles on unconventional perfusion flaps, the multiple animal species involved, the myriad vascular constructions used, and the frequently conflicting data reported make synthesis of this information challenging. The main aim of this study was to perform a systematic review and meta-analysis of the literature on the experimental use of unconventional perfusion flaps, to identify the best experimental models proposed and to estimate their global survival rate. Methods: The authors performed a systematic review and meta-analysis of all articles written in English, French, Italian, Spanish, and Portuguese on the experimental use of unconventional perfusion flaps and indexed to PubMed from 1981 until February 1, 2017. Results: A total of 68 studies were found, corresponding to 86 optimized experimental models and 1073 unconventional perfusion flaps. The overall unconventional perfusion flap survival rate was 90.8 percent (95 percent CI, 86.9 to 93.6 percent; p < 0.001). The estimated proportion of experimental unconventional perfusion flaps presenting complete survival or nearly complete survival was 74.4 percent (95 percent CI, 62.1 to 83.7 percent; p < 0.001). The most commonly reported animal species in the literature were the rabbit (57.1 percent), the rat (26.4 percent), and the dog (14.3 percent). No significant differences were found in survival rates among these species, or among the diverse vascular patterns used. Conclusion: These data do not differ significantly from those reported regarding the use of unconventional perfusion flaps in human medicine, suggesting that rabbit, rat, and canine experimental unconventional perfusion flap models may adequately mimic the clinical application of unconventional perfusion flaps.
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Casal D, Mota-Silva E, Iria I, Alves S, Farinho A, Pen C, Lourenço-Silva N, Mascarenhas-Lemos L, Silva-Ferreira J, Ferraz-Oliveira M, Vassilenko V, Videira PA, Goyri-O’Neill J, Pais D. Reconstruction of a 10-mm-long median nerve gap in an ischemic environment using autologous conduits with different patterns of blood supply: A comparative study in the rat. PLoS One 2018; 13:e0195692. [PMID: 29659600 PMCID: PMC5902043 DOI: 10.1371/journal.pone.0195692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/27/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate in the Wistar rat the efficacy of various autologous nerve conduits with various forms of blood supply in reconstructing a 10-mm-long gap in the median nerve (MN) under conditions of local ischemia. A 10-mm-long median nerve defect was created in the right arm. A loose silicone tube was placed around the nerve gap zone, in order to simulate a local ischemic environment. Rats were divided in the following experimental groups (each with 20 rats): the nerve Graft (NG) group, in which the excised MN segment was reattached; the conventional nerve flap (CNF) and the arterialized neurovenous flap (ANVF) groups in which the gap was bridged with homonymous median nerve flaps; the prefabricated nerve flap (PNF) group in which the gap was reconstructed with a fabricated flap created by leaving an arteriovenous fistula in contact with the sciatic nerve for 5 weeks; and the two control groups, Sham and Excision groups. In the latter group, the proximal stump of the MN nerve was ligated and no repair was performed. The rats were followed for 100 days. During this time, they did physiotherapy. Functional, electroneuromyographic and histological studies were performed. The CNF and ANVF groups presented better results than the NG group in the following assessments: grasping test, nociception, motor stimulation threshold, muscle weight, and histomorphometric evaluation. Radial deviation of the operated forepaw was more common in rats that presented worse results in the other outcome variables. Overall, CNFs and ANVFs produced a faster and more complete recovery than NGs in the reconstruction of a 10-mm-long median nerve gap in an ischemic environment in the Wistar rat. Although, results obtained with CNFs were in most cases were better than ANVFs, these differences were not statistically significant for most of the outcome variables.
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Affiliation(s)
- Diogo Casal
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduarda Mota-Silva
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Inês Iria
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sara Alves
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Ana Farinho
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Cláudia Pen
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | | | - Luís Mascarenhas-Lemos
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - José Silva-Ferreira
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Mário Ferraz-Oliveira
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Valentina Vassilenko
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paula Alexandra Videira
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Goyri-O’Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pais
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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9
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Casal D, Mota-Silva E, Pais D, Iria I, Videira PA, Tanganho D, Alves S, Mascarenhas-Lemos L, Martins Ferreira J, Ferraz-Oliveira M, Vassilenko V, O’Neill JG. Optimization of an Arterialized Venous Fasciocutaneous Flap in the Abdomen of the Rat. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1436. [PMID: 28894657 PMCID: PMC5585430 DOI: 10.1097/gox.0000000000001436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although numerous experimental models of arterialized venous flaps (AVFs) have been proposed, no single model has gained widespread acceptance. The main aim of this work was to evaluate the survival area of AVFs produced with different vascular constructs in the abdomen of the rat. METHODS Fifty-three male rats were divided into 4 groups. In group I (n = 12), a 5-cm-long and 3-cm-wide conventional epigastric flap was raised on the left side of the abdomen. This flap was pedicled on the superficial caudal epigastric vessels caudally and on the lateral thoracic vein cranially. In groups II, III, and IV, a similar flap was raised, but the superficial epigastric artery was ligated. In these groups, AVFs were created using the following arterial venous anastomosis at the caudal end of the flap: group II (n = 13) a 1-mm-long side-to-side anastomosis was performed between the femoral artery and vein laterally to the ending of the superficial caudal epigastric vein. In group III (n = 14), in addition to the procedure described for group II, the femoral vein was ligated medially. Finally, in group IV (n = 14), the superficial caudal epigastric vein was cut from the femoral vein with a 1-mm-long ellipse of adjacent tissue, and an end-to-side arterial venous anastomosis was established between it and the femoral artery. RESULTS Seven days postoperatively, the percentage of flap survival was 98.89 ± 1.69, 68.84 ± 7.36, 63.84 ± 10.38, 76.86 ± 13.67 in groups I-IV, respectively. CONCLUSION An optimized AVF can be produced using the vascular architecture described for group IV.
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Affiliation(s)
- Diogo Casal
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Eduarda Mota-Silva
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Diogo Pais
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Inês Iria
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Paula A. Videira
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - David Tanganho
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Sara Alves
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luís Mascarenhas-Lemos
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - José Martins Ferreira
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Mário Ferraz-Oliveira
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Valentina Vassilenko
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri O’Neill
- From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Anatomy Department, Nova Medical School, Lisbon, Portugal; Glycoimmunology, CEDOC, NOVA Medical School, Lisbon, Portugal; LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; Department of Life Sciences, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Caparica, Portugal; and Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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