Prolongation of Secondary Critical Ischemia Time of Experimental Skin Flaps Using UW Solution as a Normothermic Perfusate

1993 ◽  
Vol 108 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Ilsa Schwartz ◽  
Michel Babajanian ◽  
Wen X. Zhang ◽  
Jonathan E. Aviv ◽  
Hubert Weinberg ◽  
...  
Keyword(s):  
Skin Flap ◽  
Clinical Situation ◽  
Ischemic Tolerance ◽  
Time Interval ◽  
Skin Flaps ◽  
Critical Ischemia ◽  
Pedicle Flap ◽  
Abdominal Skin ◽  
Normothermic Perfusion ◽  
Secondary Ischemia

A myriad of investigations have been published on the pharmacologic manipulation of flaps to enhance tolerance to ischemia. We recently reported a threefold increase in ischemic tolerance of the rat abdominal skin flap pedicle after 6 hours of primary ischemia and 12 hours of reperfusion. Flaps underwent normothermic perfusion washout with lactated Ringer's or U.W. solution, a newly developed organ preservation medium. Perfusion washouts were performed at one of three different points in the protocol: (1) onset of primary ischemia; (2) onset of secondary ischemia; or (3) 2 hours after onset of secondary ischemia. The last group was used to simulate the clinical situation in which flaps are discovered and salvage procedures instituted at a delayed time interval. This is the longest normothermic ischemic interval reported. We undertook the present study to determine the utility of the U.W solution in prolonging the tolerance of the flap to a second ischemic insult after a period of reperfusion. Seventy-five unilateral rat abdominal skin flaps were raised. Secondary ischemia was produced by placing a microvascular clamp across the inferior epigastric pedicle. Flap survival was assessed at 1 week postoperatively. While none of the nonperfused flaps survived 8 hours of secondary ischemia, at least 50% of the U.W. perfused flaps survived an average of 14 hours of secondary ischemia. Lactated Ringer's perfusion washout only modestly increased the ischemic tolerance. Perfusion washout in the secondary ischemic phase improved the ischemic tolerance to a significantly greater degree than in the primary ischemic interval. (OTOLARYNGOL HEAD NECK SURG 1993;108:149-55.)

scholarly journals Application of WALANT technique for repairing finger skin defect with a random skin flap

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianhua Xu ◽  
Lu Yin ◽  
Shuming Cao ◽  
Haihua Zhan ◽  
Jianbing Zhang ◽  
...  
Keyword(s):  
Skin Flap ◽  
Donor Site ◽  
Operation Time ◽  
Pedicled Flap ◽  
Skin Defect ◽  
Skin Flaps ◽  
Abdominal Skin ◽  
Vas Score ◽  
Finger Skin ◽  
Wide Awake

Abstract Background Wide-awake local anesthesia no tourniquet (WALANT) technique has emerged among hand surgeons with other indications. Surgeries involving pedicled flap and revascularization are no longer used as contraindications. The present study aimed to evaluate the feasibility and merits of the WALANT technique in random skin flap surgery. Methods From May 2018 to March 2019, 12 patients with finger skin defects repaired with random skin flaps were reviewed. Abdominal skin flaps or thoracic skin flaps were used to cover the wound. Both the fingers and the donor sites were anesthetized by the WALANT technique. A 40-mL conventional volume consisted of a mixture of epinephrine and lidocaine. A volume of 5 mL was injected at the distal palmar for nerve block, the other 5 mL was injected around the wound for hemostasis, and the remaining was injected at the donor site of flaps for both analgesia and hemostasis. Baseline data with respect to sex, age, side, type of finger, donor sites, flap size, dosage of anesthetics, usage of finger tourniquet, intraoperative and postoperative pain, hemostasis effect, operation time, Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) score, and hospitalization expense, were collected. Results All patients tolerated the procedure, and none of them needed sedation. Single finger skin defect in 8 patients and double finger skin defect occurred in 4 patients; 5 patients were repaired by abdominal skin flaps, and 7 patients were repaired by thoracic skin flaps. The good surgical field visibility was 91.7%. All flaps survived adequately, without necrosis, pulling fingers out, and other complications. The average visual analog scale (VAS) score of the maximal pain was 1.1 in fingers vs. 2.1 in donor sites during the operation. On postoperative day one, the average VAS score of the maximal pain in fingers and donor sites was 1.3 and 1.1, respectively. The average hospitalization expense before reimbursement of the whole treatment was 11% less expensive compared to the traditional method. The average QuickDASH score was 9.1. Conclusions Under wide-awake anesthesia, patients have the ability to control their injured upper extremities consciously, avoiding the complications due to pulling flap pedicles. With the merits of safety, painlessness, less bleeding, and effectivity, the WALANT technique in random skin flaps is feasible and a reliable alternative to deal with finger skin defect.

scholarly journals Skin Flaps and Graft In Eyelid Reconstruction

2019 ◽  
Vol 8 (3) ◽  
pp. 755
Author(s):  
Khairiah Nevrianty ◽  
Hendriati Hendriati
Keyword(s):  
Skin Flap ◽  
Wide Excision ◽  
Skin Flaps ◽  
Pedicle Flap ◽  
Eyelid Reconstruction

Rekonstruksi kelopak mata merupakan salah satu operasi mata yang paling menantang karena menuntut kemungkinan hasil fungsional dan kosmetik yang terbaik. Flap dan graft merupakan suatu teknik pada bedah plastik dan rekonstruksi dengan tujuan untuk mengisi dan memperbaiki defek pada suatu luka tertentu. Prosedur skin flap dan graft dengan teknik semisirkular flap merupakan salah satu prosedur untuk rekonstruksi dengan defek luas pada kelopak mata bawah. Dilaporkan seorang pasien perempuan, usia 55 tahun dikonsulkan dari subbagian Tumor dengan diagnosa karsinoma sel skuamosa kelopak bawah mata kanan, terdapat massa pada palpebra inferior dengan ukuran  40mmx 25mmx15mm dengan bola mata dalam batas normal. Identifikasi luas defek setelah wide excision adalah sekitar 45mm x 30mm yang melibatkan margo kelopak mata dan kantus. Semicircular flap-pedicle flap dengan graft mukosa mulut dilakukan pada pasien ini. Dengan teknik ini telah dapat merekonstruksi kelopak mata inferior sehingga secara kosmetik dapat diterima oleh pasien. Terdapat komplikasi yang ditemukan yaitu lagoftalmus sebesar 3 mm setelah 1 bulan post operasi. Kesimpulan dari laporan kasus ini adalah penggunaan skin flap dan graft pada rekontruksi kelopak mata dapat menjadi solusi bila defek terlalu besar untuk dilakukan penutupan atau tidak dapat dilakukan penutupan secara primer untuk mengembalikan anatomi dan fungsi kelopak mata.

scholarly journals Skin Flaps and Graft In Eyelid Reconstruction

2019 ◽  
Vol 8 (3) ◽  
pp. 755
Author(s):  
Khairiah Nevrianty ◽  
Hendriati Hendriati
Keyword(s):  
Skin Flap ◽  
Wide Excision ◽  
Skin Flaps ◽  
Pedicle Flap ◽  
Eyelid Reconstruction

Rekonstruksi kelopak mata merupakan salah satu operasi mata yang paling menantang karena menuntut kemungkinan hasil fungsional dan kosmetik yang terbaik. Flap dan graft merupakan suatu teknik pada bedah plastik dan rekonstruksi dengan tujuan untuk mengisi dan memperbaiki defek pada suatu luka tertentu. Prosedur skin flap dan graft dengan teknik semisirkular flap merupakan salah satu prosedur untuk rekonstruksi dengan defek luas pada kelopak mata bawah. Dilaporkan seorang pasien perempuan, usia 55 tahun dikonsulkan dari subbagian Tumor dengan diagnosa karsinoma sel skuamosa kelopak bawah mata kanan, terdapat massa pada palpebra inferior dengan ukuran  40mmx 25mmx15mm dengan bola mata dalam batas normal. Identifikasi luas defek setelah wide excision adalah sekitar 45mm x 30mm yang melibatkan margo kelopak mata dan kantus. Semicircular flap-pedicle flap dengan graft mukosa mulut dilakukan pada pasien ini. Dengan teknik ini telah dapat merekonstruksi kelopak mata inferior sehingga secara kosmetik dapat diterima oleh pasien. Terdapat komplikasi yang ditemukan yaitu lagoftalmus sebesar 3 mm setelah 1 bulan post operasi. Kesimpulan dari laporan kasus ini adalah penggunaan skin flap dan graft pada rekontruksi kelopak mata dapat menjadi solusi bila defek terlalu besar untuk dilakukan penutupan atau tidak dapat dilakukan penutupan secara primer untuk mengembalikan anatomi dan fungsi kelopak mata.

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

A Model for Training in Elevation of Local Skin Flaps in the Hand

1994 ◽  
Vol 19 (6) ◽  
pp. 794-795 ◽  
Author(s):  
H. D. SKOFF
Keyword(s):  
Skin Flap ◽  
Three Dimensional ◽  
Skin Flaps ◽  
Dimensional Model ◽  
Surgical Experience ◽  
Three Dimensional Model ◽  
Local Skin ◽  
Practice Models ◽  
Flap Design

Appropriate skin flap design is crucial for success in surgery of the hand. Practice models are useful in acquiring surgical experience. The author describes a three-dimensional model composed of readily available materials which has been useful for practice in elevation of local skin flaps in the hand

Vasodilator effect and mechanism of action of vascular endothelial growth factor in skin vasculature

2004 ◽  
Vol 286 (3) ◽  
pp. H946-H954 ◽  
Author(s):  
Homa Ashrafpour ◽  
Ning Huang ◽  
Peter C. Neligan ◽  
Christopher R. Forrest ◽  
Patrick D. Addison ◽  
...  
Keyword(s):  
Skin Flap ◽  
Vegf Receptor ◽  
Vascular Endothelial ◽  
Skin Flaps ◽  
Skin Perfusion ◽  
Potent Vasodilator ◽  
Or Gene ◽  
Endothelial Growth Factor ◽  
Endothelial Nitric Oxide ◽  
First Time

Various laboratories have reported that local subcutaneous or subdermal injection of VEGF165 at the time of surgery effectively attenuated ischemic necrosis in rat skin flaps, but the mechanism was not studied and enhanced angiogenesis was implicated. In the present study, we used the clinically relevant isolated perfused 6 × 16-cm pig buttock skin flap model to 1) test our hypothesis that VEGF165 is a potent vasodilator and acute VEGF165 treatment increases skin perfusion; and 2) investigate the mechanism of VEGF165-induced skin vasorelaxation. We observed that VEGF165 (5 × 10–16–5 × 10–11 M) elicited a concentration-dependent decrease in perfusion pressure (i.e., vasorelaxation) in skin flaps preconstricted with a submaximal concentration of norepinephrine (NE), endothelin-1, or U-46619. The VEGF165-induced skin vasorelaxation was confirmed using a dermofluorometry technique for assessment of skin perfusion. The vasorelaxation potency of VEGF165 in NE-preconstricted skin flaps (pD2 = 13.57 ± 0.31) was higher ( P < 0.05) than that of acetylcholine (pD2 = 7.08 ± 0.24). Human placental factor, a specific VEGF receptor-1 agonist, did not elicit any vasorelaxation effect. However, a specific antibody to VEGF receptor-2 (1 μg/ml) or a specific VEGF receptor-2 inhibitor (5 × 10–6 M SU-1498) blocked the vasorelaxation effect of VEGF165 in NE-preconstricted skin flaps. These observations indicate that the potent vasorelaxation effect of VEGF165 in the skin vasculature is initiated by the activation of VEGF receptor-2. Furthermore, using pharmacological probes, we observed that the postreceptor signaling pathways of VEGF165-induced skin vasorelaxation involved activation of phospholipase C and protein kinase C, an increase in inositol 1,4,5-trisphosphate activity, release of the intra-cellular Ca2+ store, and synthesis/release of endothelial nitric oxide, which predominantly triggered the effector mechanism of VEGF165-induced vasorelaxation. This information provides, for the first time, an important insight into the mechanism of VEGF165 protein or gene therapy in the prevention/treatment of ischemia in skin flap surgery and skin ischemic diseases.

Critical Ischemia Time and the Failing Skin Flap

1982 ◽  
Vol 69 (6) ◽  
pp. 986-989 ◽  
Author(s):  
Carolyn L. Kerrigan ◽  
Rollin K. Daniel
Keyword(s):  
Skin Flap ◽  
Critical Ischemia ◽  
Ischemia Time

Angiogenic Synergistic Effect of Adipose-Derived Stromal Cell Spheroids with Low-Level Light Therapy in a Model of Acute Skin Flap Ischemia

2016 ◽  
Vol 202 (5-6) ◽  
pp. 307-318 ◽  
Author(s):  
In-Su Park ◽  
Phil-Sang Chung ◽  
Jin Chul Ahn
Keyword(s):  
Growth Factors ◽  
Skin Flap ◽  
Light Therapy ◽  
Skin Flaps ◽  
Low Level Light Therapy ◽  
Low Level ◽  
Cell Source ◽  
Hematoxylin And Eosin ◽  
Recipient Tissue ◽  
Regeneration Of Skin

Human adipose-derived mesenchymal stem cells (hASCs) are an attractive cell source for tissue engineering. However, one obstacle to this approach is that the transplanted hASC population can decline rapidly in the recipient tissue. The aim of this study was to investigate the effects of low-level light therapy (LLLT) on transplanted spheroid hASCs in skin flaps of mice. hASCs were cultured in monolayers or spheroids. LLLT, hASCs, spheroids and spheroids transplanted with LLLT were applied to the skin flaps. Healing of the skin flaps was assessed by gross evaluation and by hematoxylin and eosin staining and elastin van Gieson staining. Compared with the spheroid group, skin flap healing was enhanced in the spheroid + LLLT group, including the neovascularization and regeneration of skin appendages. The survival of hASCs was enhanced by decreased apoptosis of hASCs in the skin flaps of the spheroid + LLLT group. The secretion of growth factors was stimulated in the spheroid + LLLT group compared with the ASC and spheroid groups. These data suggest that LLLT was an effective biostimulator of spheroid hASCs in the skin flaps, enhancing the survival of hASCs and stimulating the secretion of growth factors.

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