Sustained (rh)VEGF165release from a sprayed fibrin biomatrix induces angiogenesis, up-regulation of endogenous VEGF-R2, and reduces ischemic flap necrosis

PURPOSE: To evaluate the influence of minoxidil, a well known vasodilator, on ischemic flap necrosis prevention in rats. METHODS: Ventral cutaneous flaps, measuring 8x4cm, were designed in 20 Wistar rats based on the right cranial epigastric artery. In the experiment group, 50 mg/kg/day of minoxidil sulfate was administered by orogastric tube and the same amount of saline solution was administered to the control group. Such procedure was initiated 24h before surgery and kept once a day through the 7th postoperative day. Microcirculation was evaluated with laser fluxometry 24h before surgical procedure, at immediate postoperative and at the 7th postoperative day. Flap necrosis area was evaluated by 2 methods: planimetry and weight/paper ratio. RESULTS: A significant flow increase in distal and medial extremity at M1 (medial point 1) (p=0,0484) was observed in the experiment group. There was significant difference in flap necrosis prevention in the experiment group (p=0,0433), although after necrosis took place there was no significant difference in necrosis size. (p=0,1051 and p=0,2799). CONCLUSION: Minoxidil sulfate is effective in avoiding necrosis in ischemic flaps, but after necrosis is present there is no difference in survival area between experimental and control groups.

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Deferoxamine Decreases Necrosis in Dorsally Based Pig Skin Flaps

Otolaryngology ◽

10.1177/019459988910100508 ◽

1989 ◽

Vol 101 (5) ◽

pp. 559-561 ◽

Cited By ~ 21

Author(s):

Gregory S. Weinstein ◽

Michael D. Maves ◽

Michael L. McCormack

Keyword(s):

Porcine Model ◽

Skin Flap ◽

Free Radical Scavenger ◽

Radical Scavenger ◽

Human Beings ◽

Flap Necrosis ◽

Flap Surgery ◽

Group 2 ◽

Ischemic Flap ◽

Group 1

Deferoxamine, a free radical scavenger and iron chelator, has been shown to improve skin flap survival in ischemic flap surgery in rats. The present study investigates the value of deferoxamine in ischemic flap surgery in the porcine model. Four 4 × 12 cm flaps, 3 cm apart and 3 cm from the dorsal midline, were elevated on each of six female pigs, weighing 50 to 60 pounds each. The animals were divided into two test groups. Group 1 received six 1 gm doses of deferoxamine in 4 ml of sterile water intramuscularly every 6 hours preoperatively for five doses, followed by the administration of 1 g every 6 hours for the first 6 days postoperatively. Group 2 received 4 ml of normal saline administered intramuscularly as above. The percentage of flap necrosis was assessed on postoperative day 7 by the weighing paper technique. Group 1 had 17.1% necrosis and group 2 had 33% necrosis ( p < 0.005). Deferoxamine has decreased flap necrosis in the porcine model and may be of use in augmenting the surviving length of flaps in human beings,

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The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

Journal of Cancer Science and Therapeutics ◽

10.36879/jcst.19.000109 ◽

2019 ◽

pp. 1-5

Keyword(s):

Decision Making ◽

Logistic Regression ◽

Skin Necrosis ◽

Regression Models ◽

Multivariable Analysis ◽

P Value ◽

Flap Necrosis ◽

Single Institution ◽

Logistic Regression Models ◽

The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

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Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck

Case Reports in Surgery ◽

10.1155/2020/8819102 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Vladislav Pavlovich Zhitny ◽

Noama Iftekhar ◽

Peter Caravella ◽

Jake Patrick Young ◽

Barry Zide ◽

...

Keyword(s):

Skin Necrosis ◽

Wound Dehiscence ◽

The United States ◽

Abdominal Wound ◽

Flap Necrosis ◽

Aesthetic Result ◽

Self Image ◽

To Receive ◽

Medical Tourist ◽

Incision Drainage

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

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Reconstruction of Tragus and External Auditory Meatus using Remnant Auricle during Microtia Reconstruction

Facial Plastic Surgery ◽

10.1055/s-0037-1617436 ◽

2018 ◽

Vol 34 (02) ◽

pp. 227-229

Author(s):

Yi-gao Hu ◽

Wei Ding ◽

Jun Tan ◽

Xin Chen ◽

Tao Luo ◽

...

Keyword(s):

Skin Flap ◽

Skin Grafting ◽

External Auditory Meatus ◽

Reconstruction Technique ◽

External Ear ◽

Flap Necrosis ◽

Second Stage ◽

The Third ◽

Third Stage ◽

Thin Skin

AbstractThis article investigates an effective method with which to reconstruct the tragus and external auditory meatus for microtia reconstruction. The external ear was reconstructed using a delayed postauricular skin flap in patients with congenital microtia. After the first stage of delaying the postauricular skin flap and the second stage of otoplasty with ear framework fabricated from autogenous rib cartilage draping with the delayed skin flap, the third stage involved tragus and external auditory meatus canaloplasty. After designing the remnant auricle flap, the lower part was trimmed and the tragus was reconstructed. The upper part was trimmed into a thin skin flap, which was rotated and used to cover the hollowed wound posterosuperior to the tragus so as to mimic the external auditory meatus. If remnant wounds were present, skin grafting was conducted. In total, 121 patients with congenital microtia were treated from March 2010 to March 2016. The reconstructed tragus and external auditory meatus were well formed, and all wounds healed well. No severe complications such as flap necrosis occurred. Six months postoperatively, the morphology of the reconstructed tragus and external auditory meatus was good. Overall, the patients and their families were satisfied. The use of remnant auricle to reconstruct the tragus and external auditory meatus is an effective auricular reconstruction technique.

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Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

Journal of Robotic Surgery ◽

10.1007/s11701-021-01265-w ◽

2021 ◽

Author(s):

M. D. Filipe ◽

E. de Bock ◽

E. L. Postma ◽

O. W. Bastian ◽

P. P. A. Schellekens ◽

...

Keyword(s):

Postoperative Complication ◽

Complication Rate ◽

Primary Outcome ◽

Meta Analysis ◽

Complication Rates ◽

Flap Necrosis ◽

Postoperative Complication Rate ◽

Common Cancer ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

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