scholarly journals Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

2013 ◽  
Vol 97 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Ruixing Hou ◽  
Jihui Ju ◽  
Qiang Zhao ◽  
Yuefei Liu
Keyword(s):  
Skin Flap ◽  
Terminal Segment ◽  
Fasciocutaneous Flap ◽  
Skin Flaps ◽  
Scar Contracture ◽  
Digital Reconstruction ◽  
Fascial Flap ◽  
Distally Based ◽  
Digital Terminal

Abstract The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n  =  765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4–36 months). The wider pedicled fascial flap (1.0–1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds.

The effect of transcutaneous electrical nerve stimulation on the viability of random skin flaps in rats

2002 ◽  
Vol 10 (4) ◽  
pp. 151-154 ◽  
Author(s):  
Richard Eloin Liebano ◽  
Lydia Masako Ferreira ◽  
Miguel Sabino Neto
Keyword(s):  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Skin Flap ◽  
Control Group ◽  
Skin Flaps ◽  
Electrical Nerve Stimulation ◽  
Flap Viability ◽  
Group 2 ◽  
Group 1

The aim of this study was to determine the role of transcutaneous electrical nerve stimulation (TENS) in the viability of random skin flaps. In 30 Wistar-EPM rats, a random 10×4 cm skin flap was raised and a plastic barrier was interposed between the flap and its bed. Immediately after surgery and for two subsequent days, the rats in group 1 (the control group) were anesthetized for 1 h with the electrodes positioned in the base of the flap and without the administration of the electric stimulus. The rats in group 2 (the treatment group) were submitted to TENS for 1 h immediately after the surgery and for two subsequent days. The percentage of necrotic area (averages of 43.11% in the rats in group 1 and 23.52% in the rats in group 2) was calculated on the seventh postoperative day in both groups. Statistical analysis proved that TENS was more efficient in increasing random skin flap viability than was the method used in the control group.

The Distally Based Ulnar Artery Island Flap in Hand Reconstruction

1997 ◽  
Vol 22 (2) ◽  
pp. 204-211 ◽  
Author(s):  
A. O. GROBBELAAR ◽  
D. H. HARRISON
Keyword(s):  
Ulnar Artery ◽  
Fasciocutaneous Flap ◽  
Venous Congestion ◽  
Island Flap ◽  
Venous Anastomosis ◽  
Hand Reconstruction ◽  
Fascial Flap ◽  
Hairless Skin ◽  
Distally Based ◽  
Composite Flap

The distally based ulnar artery island flap is a highly versatile flap for hand reconstruction. It fulfils all the necessary criteria required for a flap to the hand providing thin pliable hairless skin. It can be used as a composite flap including tendon and bone and provides an ideal tunnel for tendons to glide in. It can be used as a fasciocutaneous flap or as a fascial flap and can easily be rotated to the dorsum of the hand by opening Guyon’s canal. The palm or dorsum of the hand and even the fingertips can be reached easily. A superficial venous anastomosis should be made if marked venous congestion is noted intraoperatively. Six cases utilizing a distally based ulnar island flap in hand reconstruction are presented.

scholarly journals Effects of hyperbaric oxygen and N-acetylcysteine in survival of random pattern skin flaps in rats

2012 ◽  
Vol 45 (03) ◽  
pp. 453-458 ◽  
Author(s):  
Fernando da Rocha ◽  
Djalma Fagundes ◽  
Jefferson Pires ◽  
Fernanda Salim da Rocha
Keyword(s):  
Hyperbaric Oxygen ◽  
Skin Flap ◽  
Control Area ◽  
Random Pattern ◽  
Skin Flaps ◽  
Significant Difference ◽  
Male Wistar Rats ◽  
Flap Design ◽  
A Site

ABSTRACT Objective: Our aim is to investigate the role of HBO (hyperbaric oxygen), NAC (N-acetylcysteine), and HBO plus NAC on the necrosis area of random rat′s skin flaps of a modified McFarlane flap design. Materials and Methods: Thirty-two male Wistar rats were randomly divided into four groups: G-S (sham: n = 8), G-NAC (NAC: n = 8), G-HBO (HBO: n = 8), and G-HN (HBO plus NAC: n = 8). A rectangular skin flap (2 × 8 cm 2 ) was dissected from the muscular dorsal layer, preserving the cranial pedicle. Polyethylene film was placed over the muscular layer and an interrupted 3.0 nylon suture was employed to fix the flap into the original place. On the eighth day, full-thickness biopsy samples (2 × 1 cm 2 ) were collected from the proximal, middle, and cranial areas of the skin flap, and in a site away from the flap labelled as the control area. Results: The measurements of necrotic areas in the groups were 18.3% in G-S, 24.3% in G-NAC, 12.6% in G-HBO, and 14.9% in G-HN. Significant difference was observed between the groups G-HBO and G-HN as well as G-NAC. Conclusion: HBO is associated with reduced area of necrosis of skin flap. The G-NAC group was associated with poor results when examined in isolation. The association between HBO and NAC did not produce favourable results with respect to the use of HBO alone. These findings suggest that the diffusion of oxygen through the interstitial space was the determining factor of more favourable results of HBO.

The Role of Photoplethysmography in the Prediction of the Experimental Flap Survival

1978 ◽  
Vol 86 (3) ◽  
pp. ORL-492-ORL-497 ◽  
Author(s):  
Janusz Bardach ◽  
Richard J. Voots ◽  
Brian F. McCabe ◽  
Mow Ming Hsu
Keyword(s):  
Skin Flap ◽  
Skin Flaps ◽  
Arterial Blood ◽  
Flap Viability ◽  
Significant Difference ◽  
Blood Density ◽  
Density Scale ◽  
Experimental Flap ◽  
Venous Vasculature

A standard photoplethysmograph, modified to differentiate between arterial and venous vasculature in skin tissue, has been used to measure arterial supply in 100 unipedicle skin flaps in 25 pigs. A datum transform from a light intensity scale to a relative arterial blood density scale has been introduced and empirically labeled the vascular coefficient (VC). Statistical analysis of the VC data shows a significant difference between necrotic and surviving flap group mean data as early as 24 hours. Additional analysis in which a normal ogive was fitted to the sample VC data distributions suggests that statistically significant predictions of the probability of eventual flap necrosis can be made using VC measurements obtained immediately postoperatively. It is concluded that the modified photoplethysmograph, in conjunction with the VC data transform, constitutes a usable measuring technique for skin flap viability prediction in the experimental animal.

scholarly journals Ischemia Regulates Endoglin Expression in a Pig Skin Flap Model

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Toni Nimeh ◽  
Roya Haghighat-Mortazavi ◽  
Kayvan Khiabani ◽  
Noura Malek, B.Sc. ◽  
Kevin Watters ◽  
...  
Keyword(s):  
Transforming Growth Factor ◽  
Transmembrane Protein ◽  
Skin Flap ◽  
Skin Flaps ◽  
Exact Role ◽  
Pig Skin ◽  
Induced Changes ◽  
Therapeutic Avenue ◽  
Control Skin

Endoglin is a transmembrane protein that binds transforming growth factor b (TGF-b) with high affinity. It is thought to modulate TGF-b signaling and responses through interactions on cell surfaces with TGF-b receptors. It is highly expressed on endothelial cells of tissues undergoing angiogenesis. Since ischemia-induced changes such as angiogenesis are in part regulated by TGF-b, it is important to elucidate the precise mechanism by which they occur if we are to influence the effects of ischemia on tissue. Since endoglin is one of the receptors involved in regulating TGF-b signaling, we tested whether endoglin expression will increase in response to ischemic injury. A pig skin flap model was developed and used in our laboratory to study the effect of ischemia on the expression of endoglin and its ligand TGF-b1 using immunohistochemistry. We observed an increased expression of endoglin and TGF-b1 in the epidermal layer, blood vessels, and fibroblasts in ischemic skin flaps as compared to non-ischemic control skin flaps. Given the role of TGF-b and endoglin in angiogenesis, this may represent a mechanism by which ischemia stimulates angiogenesis. Much work remains to be done to delineate the exact mechanisms by which TGF-b acts and the exact role of endoglin in TGF-b signaling. Understanding how to regulate the actions of TGF-b by manipulating the expression of endoglin may provide a therapeutic avenue given the importance of TGF-b in tumour angiogenesis.

Ca2+-Myristoyl Switch in Neuronal Calcium Sensor-1: A Role of C-Terminal Segment

2015 ◽  
Vol 14 (4) ◽  
pp. 437-451 ◽  
Author(s):  
Viktoriia Baksheeva ◽  
Aliya Nazipova ◽  
Dmitry Zinchenko ◽  
Marina Serebryakova ◽  
Ivan Senin ◽  
...  
Keyword(s):  
Terminal Segment ◽  
Calcium Sensor ◽  
Neuronal Calcium Sensor ◽  
Myristoyl Switch

scholarly journals Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yuan Li ◽  
Qi-lin Jiang ◽  
Leanne Van der Merwe ◽  
Dong-hao Lou ◽  
Cai Lin
Keyword(s):  
Systematic Review ◽  
Stem Cells ◽  
Stem Cell ◽  
Survival Rate ◽  
Meta Analysis ◽  
Skin Flap ◽  
Cochrane Library ◽  
Skin Flaps ◽  
Cell Based Therapy ◽  
Stem Cell Treatment

Abstract Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.

Effect of Hyperthermic Preconditioning on the Survival of Ischemia-Reperfused Skin Flaps: A New Skin-Flap Model in the Mouse

2002 ◽  
Vol 18 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Trinh Cao Minh ◽  
Shigeru Ichioka ◽  
Takashi Nakatsuka ◽  
Junsuke Kawai ◽  
Masahiro Shibata ◽  
...  
Keyword(s):  
Skin Flap ◽  
Skin Flaps ◽  
Hyperthermic Preconditioning ◽  
New Skin
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