The esthetic outcome of recipient sites of gracilis muscle flaps versus anterolateral thigh flaps: A retrospective study

BACKGROUND

Anterolateral thigh (ALT) and gracilis muscle flaps have been described as comparable reconstructive options regarding maximal flap dimension and indications. However, split-thickness skin-grafted muscle flaps are generally believed to be inferior to perforator flaps regarding the esthetic outcome of the recipient site. The purpose of this study was to challenge this assumption, comparing the long-term esthetic outcome of the gracilis and the ALT flap.

METHODS

One hundred forty-eight patients who had undergone free flap reconstruction with either free split-thickness skin-grafted gracilis muscle flaps (n = 86) or ALT flaps (n = 62) were evaluated in the study. Patients' satisfaction with the esthetic outcome, rates of flap loss, wound healing disorders and the necessity for thinning the flap or scar correction procedures were assessed.

RESULTS

Flap loss occurred in 4 of 86 gracilis flaps (4.7%) and 2 of 62 (3.2%) ALT flaps (p > .9999). Thinning or scar correction procedures were necessary for 6 of 86 gracilis (7.0%) and 4 of 62 (6.5%; p > .9999) ALT flap recipient sites. Regarding the overall patients' satisfaction with the esthetic outcome, scores were similar in both groups (2.667 [ALT] vs. 2.348 [gracilis]; p = .3739). Contour deformity, scar hypertrophy, and difference in flap color/texture in relation to the surrounding skin were comparable throughout the ALT and gracilis group (2.667 vs. 2.174, p = .2099; 3.333 vs. 2.739, p = .0912 and 2.500 vs. 2.174, p = .3159, respectively).

CONCLUSION

The gracilis and ALT flap are two equivalent reconstructive options regarding the esthetic outcome of the recipient site and long-term patient satisfaction.

Transitional changes in the structure of C-reactive protein create highly pro-inflammatory molecules: Therapeutic implications for cardiovascular diseases

C-reactive protein (CRP) is the prototypic acute-phase reactant that has long been recognized almost exclusively as a marker of inflammation and predictor of cardiovascular risk. However, accumulating evidence indicates that CRP is also a direct pathogenic pro-inflammatory mediator in atherosclerosis and cardiovascular diseases. The 'CRP system' consists of at least two protein conformations with distinct pathophysiological functions. The binding of the native, pentameric CRP (pCRP) to activated cell membranes leads to a conformational change resulting in two highly pro-inflammatory isoforms, pCRP* and monomeric CRP (mCRP). The deposition of these pro-inflammatory isoforms has been shown to aggravate the localized tissue injury in a broad range of pathological conditions including atherosclerosis and thrombosis, myocardial infarction, and stroke. Here, we review recent findings on how these structural changes contribute to the inflammatory response and discuss the transitional changes in the structure of CRP as a novel therapeutic target in cardiovascular diseases and overshooting inflammation.

Dermatofibrosarcoma protuberans in a young patient with epidermolysis bullosa: a case report

Background

Epidermolysis bullosa is a group of rare inherited skin diseases characterized by blister formation following mechanical skin trauma. Epidermolysis bullosa is associated with increased skin cancer rates, predominantly squamous cell carcinomas, yet to our best knowledge, there is no reported case of dermatofibrosarcoma protuberans in a patient with Epidermolysis bullosa.

Case presentation

Here, we present a 26-year-old man with junctional epidermolysis bullosa, who developed a DFSP on the neck. Initial, the skin alteration was mistakenly not considered malignant, which resulted in inadequate safety margins. The complete resection required a local flap to close the defect, which is not unproblematic because of the chronic inflammation and impaired healing potential of the skin due to Epidermolysis bullosa.

Conclusions

To our best knowledge, this is the first reported case of a skin-associated sarcoma in a patient with EB; however, further investigation is required to verify a correlation.

Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test.

Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS).

Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p < 0.0001). Furthermore, donor-site numbness was significantly greater in the ALT group than in the gracilis group (p = 0.0068).

Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

Quantitative enantioselective Raman spectroscopy

Analytical methods for quantitative enantioselective measurements are highly desirable in the life sciences. A Raman spectroscopy approach for the determination of concentration and enantiomer ratio is proposed.

Notizen: Kristallstruktur von [Et4N][PBr4]. Strukturkorrelation für Halogenophosphate(III) / Crystal Structure of [Et4N][PBr4]. Structural Correlation for Halogenophosphates(III)

The tetrabromophosphate(III) anion in [Et4N][PBr4] displays an extremely distorted Ψ-trigonal bipyramidal structure with axial P-Br distances of 2.970(2) and 2.305(2) Å. A structural correlation of bond distances in characterized halogenophosphates(III) indicates that such an asymmetric three-centre Br-P ··· Br interaction represents an energy minimum for isolated anions.

Trioktaedrische Halogenoarsenate(III) [As3X12]3− (X = Br, I) mit Ecken- und Flächenverknüpfung. Strukturkorrelation für Iodoarsenate(III) / Trioctahedral Haloarsenates(III) [As3X12]3− (X = Br, I) with Vertex and Face Sharing. Structural Correlation for Iodoarsenates(III)

The haloarsenates(III) [Et3NH]3[As3Br12] (1) and [Me3NH]3[As3I12] (2) have been prepared and their structures established by X-ray analysis. Both trioctahedral anions display a novel structure in which a central AsX6 octahedron shares two faces with a common vertex with two terminal AsX6 octahedra. The bridging As–X-bonds in the latter building units are markedly longer than the opposite terminal As–X-bonds in both anions. For example, the former As–I-bonds in [As3I12]3− lie in the range 3.154(1)-3.400(1)A, the latter As – I-bonds between 2.581(1) and 2.656(1)A. The distortion of the central AsX6 octahedron is less marked for both anions, e.g. the As–I distances in [As3I12]3− lie in this central polyhedron between 2.706(1) and 3.048(1) A. Using the results for (2) and for other characterised anions, a structural correlation is presented for 28 trans-sited As–I bond distances in iodoarsenates(III).

[The medical treatment of Kim Phúc at the BG Unfallklinik Ludwigshafen]

The Vietnam War was a military conflict in Vietnam during the Cold War that followed the First Indochina War. This war was fought between North Vietnam, supported by its communist allies, and the government of South Vietnam, supported by the USA and other anti-communist countries. Kim Phúc is the child depicted in the Pulitzer Prize winning photograph taken on June 8, 1972 by AP photographer Nick Út. The iconic photo shows her at about nine years of age running naked on a road amid the chaos after being severely burned by a napalm attack. After 14 months of hospital stay and 17 surgical procedures Kim Phúc was able to return home. Since then, she was used as a propaganda symbol by the communist government of Vietnam. To continue her studies, Kim was granted permission to move to Cuba where she met her future husband. However, the sequelae of her burn wounds affected her everyday life enormously. In 1984, with the support of the international aid organization "terre des hommes" and the German magazine "STERN", Kim Phúc got the opportunity to meet and get treated by Professor Zellner. Professor Peter Rudolph Zellner was the first chief of the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, and one of the founder members of the German Society of Plastic Surgeons. The reconstructive surgeries provide Kim Phúc an almost normal life. Later on, she was involved in international aid organizations; she was named a UNESCO Goodwill Ambassador and she was awarded several honorary Doctorates of Law. Kim Phúc became a Canadian citizen. Today, she lives with her husband and two children in Ontario, Canada.

S3-5: Next Generation Sequencing Reveals Co-Activating Events in the MAPK and P13K/AKT Pathways in Metastatic Triple Negative Breast Cancers

INTRODUCTION: The clinical application of next generation sequencing to comprehensively characterize groups of driving mutations in individual metastatic triple negative breast cancer (mTNBC) genomes has the potential to reveal therapeutically relevant pathway dependencies. Towards this end, we harvested tissue from 14 patients with mTNBC and are conducting deep whole genome and transcriptome sequencing for each case to identify mutations that can guide therapeutic targeting within available phase I/II clinical trials.

METHODS: Metastatic tumor tissue was harvested from 14 mTNBC patients, and 7 samples have undergone total genome and transcriptome sequencing with the others currently underway. We are utilizing the Life Technologies SOLiD® system to sequence germline and tumor DNA to sufficient depth to identify somatic genome alterations including point mutations, indels, and structural events including translocations. Furthermore, RNA-seq is being performed on these tumors, along with a series of age- and ethnicity-matched normal breast controls to perform deep differential expression analysis, isoform expression analysis, and fusion transcript detection. Our team of genome scientists and clinical oncologists are evaluating the sequencing findings and are prioritizing the investigational therapeutic options for each patient.

RESULTS: Our whole genome and transcriptome sequencing study has revealed numerous known and novel mutations in mTNBC. However, all patients’ cancers analyzed to date had alterations that would activate the MAPK pathway, but through various mechanisms in different patients. These include BRAF amplification and overexpression, NF1 homozygous deletion, and consistent IQGAP3 overexpression. Furthermore, all patients’ cancers also harbor mutations that would activate the PI3K/AKT pathway including PTEN homozygous deletion or down-regulation, consistent INPP4B down-regulation, FBXW7 homozygous deletion, and ERAS overexpression. Moreover, although we and others show ERBB4 down-regulation in breast tumors, we are the first to report unique somatic genomic events that significantly alter the ERBB4 locus leading to its loss in the majority (5/7) of our patients’ tumors. Importantly, we are beginning to use these insights to prioritize therapeutic targeting and have observed that one chemotherapy-refractory mTNBC patient, with a high-level BRAF amplification/overexpression along with down-regulation of PTEN and INPP4B, had a major response to combined mek plus akt inhibitors on a phase I study.

CONCLUSIONS: Comprehensive genomic and transcriptomic interrogation of mTNBCs has revealed events supporting co-activation of the MAPK and PI3K/AKT pathways in all the tumors albeit by different mutational mechanisms and supports potential effectiveness of combination therapy in the treatment of mTNBC. We plan to treat these patients with combined mek plus akt inhibitors on a new phase I study beginning in August 2011 to determine the effectiveness of co-inhibition of these pathways based on this frequent genomic context.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S3-5.

Characterization of a fast gas analyzer based on Raman scattering for the analysis of synthesis gas

A sensor system for fast analysis of synthesis gas (mixtures of CO and H(2)) is proposed and characterized. The system is based on spontaneous Raman scattering, which enables simultaneous concentration measurements of all relevant species. For typical synthesis gas applications, this system has to face large variations of temperature and pressure. In addition, strong fluctuations in mixture composition may occur, which lead to rather inconvenient signal intensities. In this paper, we describe a low resolution spectrometer designed to function as a synthesis gas sensor and characterize pressure and temperature effects on concentration measurements. In addition, the use of different spectral ranges and calibration strategies is investigated in view of measurement accuracy and precision.

Music perception in electric acoustic stimulation users as assessed by the Mu.S.I.C. test

AIMS

This study compared the music perception abilities of 13 electric acoustic stimulation (EAS) users with two control groups: unilateral cochlear implant (CI) users and normal-hearing (NH) listeners.

METHODS

Groups were matched according to age and musical experience before hearing loss (HL) and tested using the Musical Sounds in Cochlear Implants (Mu.S.I.C.) test.

RESULTS

No difference was found on rhythm perception, chord discrimination, dissonance rating, and emotion rating subtest performance between groups. Mean frequency discrimination scores were significantly better in EAS participants than in CI participants and not significantly worse than in NH participants. However, the EAS and CI groups scored similarly (significantly worse than NH participants) on both instrument detection and identification. Results for EAS participants were not significantly worse when the hearing aid component was removed. Frequency of listening to music before HL was negatively correlated with EAS participants' frequency discrimination scores, though singing and playing an instrument appeared to have no effect. EAS participants who indicated many reasons for listening to music and who listen to many genres after implantation scored higher on instrument detection and instrument identification. Better results on these two subtests were correlated with EAS participants' better postoperative auditory thresholds at 250 and 500 Hz.

CONCLUSIONS

Though EAS participants performed better on music perception testing (though not timbre-based tasks) than CI participants, their scores did not reach the level of NH participants. This indicates that acoustic hearing in the low frequencies is helpful for music perception, though not the only important factor.

Electrode features for hearing preservation and drug delivery strategies

BACKGROUND/AIMS

Reducing the risk of hearing loss after cochlear implantation requires optimization of the electrode array to minimize the physical trauma caused by insertion and placement. Furthermore, the electrode design must be optimized for atraumatic surgical approaches. Even greater levels of protection may be achieved by the use of a drug during and after implantation. The electrode array offers a potential vehicle for drug delivery.

METHODS

This article reviews the laboratory and clinical data available thus far relating to the importance of electrode design parameters for trauma minimization, and the possibility of further reduction through pharmaceutical intervention. Candidate drugs were identified through literature review and laboratory evaluation. The most promising have been investigated in vitro and in animal models of implantation trauma. Three delivery devices are currently under development to satisfy the specific demands of different therapy regimes. The delivery profiles of each were evaluated through both modelling and bench testing and the concepts investigated in vitro and in vivo.

RESULTS

Current evidence favours a thin, flexible electrode array with wires in a zigzag shape. Steroids and an apoptosis inhibitor (AM111) performed well in animal models of electrode trauma and are both good drug candidates for reduction of the risk of hearing loss after implantation. Semi-chronic dexamethasone elution, acute drug delivery by intracochlear catheter, and longer-term delivery through diffusion from a reservoir were all shown to be feasible.

CONCLUSION

An extensive programme focussed on minimizing hearing loss through device optimization and the development of new technologies has yielded positive results and new concepts for further development and clinical application.

Heavy Ion-induced DNA Double-strand Breaks in Yeast

DNA double-strand break (dsb) induction in diploid yeast was measured by neutral sucrose sedimentation after exposure to very heavy ions with values of linear energy transfer (LET) ranging from about 300 to 11500 ke V/microns. Linear fluence dependencies were found in all cases from which dsb production cross-sections (sigma dsb) could be calculated. Corresponding cross-sections for cell killing (sigma i) were derived from final slopes of survival curves measured in parallel and for the same fluence range. A close correlation was found between sigma i and sigma dsb. It is calculated that over the entire LET range, including 30 MeV electron irradiation, about 22 dsb are induced per lethal event when high exposures are considered.

The polycomb complex protein mes-2/E(z) promotes the transition from developmental plasticity to differentiation in C. elegans embryos

We have used expression profiling and in vivo imaging to characterize Caenorhabditis elegans embryos as they transit from a developmentally plastic state to the onset of differentiation. Normally, this transition is accompanied by activation of developmental regulators and differentiation genes, downregulation of early-expressed genes, and large-scale reorganization of chromatin. We find that loss of plasticity and differentiation onset depends on the Polycomb complex protein mes-2/E(Z). mes-2 mutants display prolonged developmental plasticity in response to heterologous developmental regulators. Early-expressed genes remain active, differentiation genes fail to reach wild-type levels, and chromatin retains a decompacted morphology in mes-2 mutants. By contrast, loss of the developmental regulators pha-4/FoxA or end-1/GATA does not prolong plasticity. This study establishes a model by which to analyze developmental plasticity within an intact embryo. mes-2 orchestrates large-scale changes in chromatin organization and gene expression to promote the timely loss of developmental plasticity. Our findings indicate that loss of plasticity can be uncoupled from cell fate specification.

[Correction of ear malformations with autologous rib cartilage]

INTRODUCTION

Ear malformations are mainly isolated deformations but exist also in combination with various syndromes. A visible malformation in cases of microtia is a problem for the entire family. Auricular reconstruction with autologous cartilage has been well established in the last decade. Optimization of the technique has led to improved and reliable results.

OPERATION AND RESULTS

Based on the experience of 120 cases we developed a concept that allows total ear reconstruction in two operative steps. In the first operation autologous rib cartilage is harvested and a natural framework is created following the template from the opposite ear. The ear remnant is transposed and the framework placed in a subcutaneous pocket on the mastoid plane. After a healing period of around 6 weeks the second operation reconstructs the auricular projection and the retroauricular fold.

CONCLUSION

Based on an individualized surgical treatment, auricular reconstruction with autologous rib cartilage are possible from the age of around 8 to the advanced period of life with reproducibly good results.