Circulatory changes after prolonged ischemia in the epigastric flap

Skin necrosis due to post-treatment care failure after photodynamic therapy of facial port-wine stain in Sturge-Weber Syndrome - A case report

We report on a case of photodynamic therapy (PDT) of large facial port-wine stain (PWS) in 5-year-old patient with Sturge-Weber Syndrome (SWS). Improvement was achieved after the first session without severe adverse reactions, however, prolonged swelling, infection and skin necrosis occurred after the second session, mainly due to failure of post-treatment care. The case demonstrates that post-treatment care is critical for PDT of large facial PWS, particularly for SWS patients.

Ischemia-reperfusion injury in a rat microvascular skin free flap model: A histological, genetic, and blood flow study

Ischemia reperfusion injury is associated with tissue damage and inflammation, and is one of the main factors causing flap failure in reconstructive microsurgery. Although ischemia-reperfusion (I/R) injury is a well-studied aspect of flap survival, its biological mechanisms remain to be elucidated. To better understand the biological processes of ischemia reperfusion injury, and to develop further therapeutic strategies, the main objective of this study was to identify the gene expression pattern and histological changes in an I/R injury animal model. Fourteen rats (n = 7/group) were randomly divided into control or ischemia-reperfusion group (8 hours of ischemia). Microsurgical anastomoses were objectively assessed using transit-time-ultrasound technology. Seven days after surgery, flap survival was evaluated and tissue samples were harvested for anatomopathological and gene-expression analyses.The I/R injury reduced the survival of free flaps and histological analyses revealed a subcutaneous edema together with an inflammatory infiltrate. Interestingly, the Arginase 1 expression level as well as the ratio of Arginase 1/Nitric oxide synthase 2 showed a significant increase in the I/R group. In summary, here we describe a well-characterized I/R animal model that may serve to evaluate therapeutic agents under reproducible and controlled conditions. Moreover, this model could be especially useful for the evaluation of arginase inhibitors and different compounds of potential interest in reconstructive microsurgery.

A hemodynamic study of the effects of arterial anastomoses with interrupted simple versus horizontal mattress sutures on rat epigastric flap perfusion

The effects of interrupted simple versus horizontal mattress sutures and of the internal diameter of the arterial pedicle at the level of the anastomosis on rat epigastric flap perfusion were investigated. In the first group, a microclip was applied to the femoral artery for 30 minutes. In the second group, the artery was cut, and a classic 7- to 8-suture microarterial end-to-end anastomosis was performed. In the third group, the artery was cut, and a microarterial end-to-end anastomosis with 3 horizontal mattress sutures at 120-degree intervals was performed. Perfusion was measured using a laser Doppler flowmeter (Periflux 2B, Perimed, Sweden) at 3 zones of the flap at 30 and 60 minutes and at 21 days after the procedure. Internal vascular diameters were measured histopathologically. Perfusion was better in the control group than in the experimental groups. However, the internal vascular diameters were greater with the classic method than with the new method, and the perfusion did not differ statistically in the anastomosis groups. In conclusion, even when significant narrowing develops at the anastomosis, flap viability is not affected.