ABSTRACT
If we could predict the necrosis of the flap caused by reperfusion injury, we can minimize the necrosis of the flap by taking appropriate action before necrosis begins. In this study, we examined whether we can predict the survival of flap under reperfusion injury or not, by measuring laser doppler flow meter values. We divided the group into the control and experimental groups corresponding to 6, 8, 9, 10, and 12hours after reperfusion(hours after ligation of auricular central artery). In each group, we examined necrotic change, perfusion unit (PU), serum superoxide dismutase (SOD), glutathione peroxidase, angiography and pathologic findings. No necrosis was observed in the 6 and 8 hours group but 8, 18, 20 hours after ligation, necrosis was observed, Also in each of 9, 10 and 12 hours group (each group consisted of 20 flaps), necrosis were noted. According to the above data, the critical time of necrosis in the auricular skin flap model lies between about 8 to 9 hours. Comparing the PU between the necrosis and non-necrosis groups, the former group showed a mean 39.57 PU increase after 60 min of reperfusion, and the latter group showed a mean increase of 21.21 PU. We can conclude that better flow can dilute oxygen free radical into systemic circulation, and this means less injuries are caused on vessels. Our study implies that if blood flow increase is less than 30 PU, intensive care is needed to save the flap. Additionally, we found significant decrease of serum SOD and glutathione peroxidase in the necrotic group. Therefore, monitoring these serum markers will be helpful in predicting reperfusion injury and supplementing these enzymes could be helpful to save the flap. The laser doppler flow meter is thought to be helpful in clinical circumstances for evaluating the circulation of the flap after the operation. However, more accumulation of clinical studies should be necessary establishing useful clinical data.
Subject(s)
Angiography , Biomarkers , Glutathione Peroxidase , Critical Care , Ligation , Necrosis , Oxygen , Perfusion , Reperfusion , Reperfusion Injury , Skin , Superoxide DismutaseABSTRACT
Axillary osmidrosis caused by excessive secretion of apocrine glands, which causes an malodor and extreme social embarrassment. To remove the apocrine glands, various types of treatment methods for axillary osmidrosis have been introduced. They could be summarized as manual of instrumental subdermal shaving, ultrasonic assisted liposuction, Botox(R) injection, electrical probe, laser dessication, etc. Surgical removal of apocrine glands has been the favored treatment for the several decades, but such complications as long-term postoperative immobilization period, skin necrosis, hematoma, and visible scars have been frequent. Recently, for the purpose of reducing these complications, some operators have advocated other procedures such as axillary ultrasonic assisted liposuction, Botox(R) injection, laser dessication. From March 2002 to April 2003, we have corrected the axillary osmidrosis in 80 cases using the subdermal shaving(24 cases), ultrasonic assisted liposuction(20 cases), Botox(R) injection(10 cases), electrical probe(26 cases). Of these operation, manual dermal shaving had the lowest recurrence rate, but disadvantages of this procedure was 4-5cm axillary scar, moderate post operative complication, long immobilization period. Otherwise Ultrasonic assisted liposuction had many advantages which were simple operation technique, short operation time, early recovery of social activity, rare post operative complication, invisible scar, lower recurrence rate. In case of Botox(R) injection was also simple operation technique, but which was short term effect about 6 months so it was necessary to treat repetitive injection but relatively high recurrence rate in severe osmidrosis. In case of electrical probe was also simple operation technique, but which was vague treatment effect, need to repetitive operation and relatively high recurrence rate in severe osmidrosis. In comparative evaluation of these methods, ultrasonic assisted liposuction was considered better results to osmidrosis treatment than others method in many aspects.