Valproic acid and ivermectin increase GABA levels to improve the viability of skin flaps in rats

Background: Gamma-aminobutyric acid (GABA) is a nonproteinogenic amino acid known as the main inhibitory neurotransmitter in the central nervous system. Ivermectin (IVM) and valproic acid (VA), both increase GABA levels. The purpose of this study was to determine the effect of VA and IVM on the viability of extended random-pattern skin flaps in Wistar rats and their GABA-dependent mechanisms. Methods: This experimental study used 32 Wistar rats that underwent surgery to have caudally based extended random-pattern skin flaps divided into four distinct groups. In the first group, 0.05 mg/kg IVM was administered via intraperitoneal (i.p.) injection 30 minutes (min) prior to elevating the flap. The second group was administered 100 mg/kg VA by i.p. injection 60 min prior to elevating the flap. The third group was administered VA 100 mg/kg followed by IVM 0.05 mg/kg injected (i.p.) 60 min and 30 min prior to flap elevation, respectively. The fourth group was used as a control. After 7 days, the percentage of flap viability was measured, and tissue sampling was performed to examine GABA levels. Results: It was found that the highest viability rate was in the group administered VA combined with IVM (93.98%) compared to all other groups (p<0.001). The highest GABA levels in the tissue were observed in the group administered VA combined with IVM (284.91 nmol/l) compared to all other groups (p<0.001). Conclusions: IVM in combination with VA improves the viability of extended random-pattern skin flaps by increasing GABA levels.

Post mastectomy breast reconstruction with autologous latissimus dorsi flap: a study of 30 cases

Background: There is a growing demand for breast reconstruction and among the plethora of breast reconstruction techniques, the latissimus dorsi (LD) flap is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities for a variety of breast defects. The aim of this study was to find out the advantages of immediate breast reconstruction in terms of postoperative morbidity and patient satisfaction with respect to her expectations.Methods: The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. Thirty female patients who had undergone immediate breast reconstruction with latissimus dorsi flap after modified radical mastectomy attending surgery department from November 2017 to September 2019 were taken. The follow up was done to find out post-operative complications and a statistical scoring was done according to rating scale of quality of life.Results: Most common complication after breast reconstruction with LD flap was found to be seroma formation (50%) followed by wound infection and flap necrosis 25% each while flap necrosis >20% was not found in any case. For emotional feeling regarding health, social activities, overall health and quality of life; there was significant improvement after surgery.Conclusions: It can be concluded that immediate breast reconstruction with autologous latissimus dorsi flap is the treatment of choice following mastectomy in cases of breast carcinoma, whenever possible.

Application of specially-designed clothing in dressing the wound of patients after breast cancer surgery / 现代临床护理

Objective To investigate the preventive effect of specially-designed clothing on dressing the wound of panents after breast cancer surgery. Methods Using random number table, we divided 400 patients having undergone breast cancer surgery into the observation group and control group in equal number. In the control group, the patients wore ordinary patient clothing after dressing the chest wound with compression bandage,and in the observation group the patients wore the specially-designed clothing after the same treatment of the chest wound as that in the control.The two groups were compared in terms of the incidence of subcutaneous effusion,incidence of skin flap necrosis and the difference of patients'comfort. Results The incidences of subcutaneous effusion and skin flap necrosis were significantly lower than those in the control group.The patient was more comfortable than that the control group, with statistically significant differences (P<0.05,P<0.01). Conclusion After breast cancer surgery,the specially-designed clothing for the patients can effectively reduce the incidences of subcutaneous effusion and incidence of skin flap necrosis and improve the patient's comfort,and deserve clinical promotion.

Prevention effect of specimen skin transplantation for skin flap necrosis after breast cancer surgery / 中国现代普通外科进展

Objective:To study the prevention effect of specimen skin transplantation for skin flap necrosis after breast cancer surgery.Methods:A retrospective analysis of 116 patients with breast cancer treated by surgery from January 2015 to November 2015 was reviewed,with skin graft in 58 cases,recorded as the observation group;skin graft was not accepted in 58 cases,as the control group,compared skin flap necrosis rate between the two groups after the operation,the operation index (operation time,hospitalization time,follow-up time and two times the proportion of skin graft),and before and after the operation of the IL-1 β,IL-6 and TNF-α levels.Resultes:The observation group of full-thickness skin flap necrosis of skin flap necrosis ratio was 0,the total incidence rate was 8.62％,which were significantly lower than the control group of 8.62％ and 25.86％,the differences were statistically significant(P＜0.05).Hospitalization time of the observation group and two skin graft ratio were significantly less than the control group,the differences were statistically significant (P＜0.05).The two groups after the IL-1 β,IL-6 and TNF-α respectively was significantly lower than that before treatment,the difference was statistically significant (P＜0.05).The patients in the observation group of IL-1 β,IL-6 and TNF-α respectively was significantly lower than the control group,the difference was statistically significant (P＜0.05).Conclusions:For large masses of breast cancer patients,under the premise of clear skin edge there is no residual cancer,through specimen skin transplantation can better prevention of skin flap necrosis after,at the same time,can promote the rehabilitation of patients,the effect is good,it is worth to give recommendation.

Analysis on influencing factors of concurrent free anterolateral femoral skin flap repair in radical operation for oral cancer / 局解手术学杂志

Objective To explore the curative effect of oral cancer radical surgery plus free anterolateral thigh flap repair and analyze the influence factors of skin flap necrosis.Methods The data of 98 patients who underwent oral cancer radical surgery with concurrent free anterolateral thigh flap repair in our hospital from January 2010 to June 2015 were retrospectively analyzed.The complete survival rate of skin flaps and incidence of complications in all patients were statistically analyzed.The age,diabetes,infection in implanted skin flap area,smoking and mental status,etc.of patients with survived or necrotic skin flaps were compared between patients with survival flaps and patients with flap necrosis,and multivariate Logistic regression analysis was performed.Results Among the 98 cases,86 cases of flaps survived completely and the survival rate was 87.8%.Fifteen cases with the skin flap necrosis,the incidence of complications was 15.3%,including 7 cases of surgi-cal site infection and 5 cases of skin flap necrosis with massive hemorrhage.The donor site incisions of all patients were primary healing and the patients were satisfied with the postoperative appearance.Among the patients with flap necrosis,the incidence rates of ≥60 years old,with diabetes,infection in flap implanted area,smoking and poor mental state (41.7%,41.7%,58.3%,75.0%,83.3%)were higher than those corresponding proportions in the patients with with survival flaps(P <0.05).Multivariate Logistic regression analysis showed that age,diabe-tes,infection in implanted skin flap area,smoking and poor mental status were the influencing factors for flap necrosis.Conclusion Oral cancer radical surgery with concurrent free anterolateral thigh flap repair has good curative effects.The age,combined with diabetes,smoking,infec-tion in flap implanted area and poor mental state are the risk factors for flap necrosis in patients with oral cancer after flap repair,which should be given intervention to improve the survival rate of skin flap in clinic.

Clinical Observation of Sanqi Shengji Ointment Preventing Skin Flap Necrosis / 中国药房

OBJECTIVE:To observe the clinical effects of Sanqi shengji ointment (SQSJO) preventing skin flap necrosis. METHODS:75 cases of local flap transfer in head and facial operation were randomly divided into blank group,treatment group, control group and with 25 cases in each group. After surgery,except for conventional treatment,treatment group was coated with SQSJO additionally;control group was additionally treated with rh-bFGF. The dressing was changed with iodophor in blank group conventionally till the wound healed. The skin flap necrosis,healing course,local skin temperature,swelling disappearance time and wound healing time were observed and compared among 3 groups after surgery. RESULTS:Compared with blank group,the incidence of skin flap necrosis decreased significantly in other 2 groups,there was statistical significance(P0.05);the flap swelling disappearance time and wound healing time of treatment group were significantly shorter than those of control group and blank group;there was statistical significance (P<0.05). CONCLU-SIONS:SQSJO can prevent skin flap necrosis accurately after flap transfer,and has no significant difference from rh-bFGF in pre-vention effect. Moreover,it is better than rh-bFGF in improving local swelling and shortening wound healing.

Latissimus Dorsi Flap for Secondary Breast Reconstruction after Partial TRAM Flap Loss

PURPOSE: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. METHODS: Case1: A 50-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. RESULTS: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. CONCLUSION: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstruction.

Experimental Study on the Prevention of Skin Flap Necrosis after Modified Radical Mastectomy in Breast Cancer by Procaine / 医学研究杂志

Objective To evaluate the effect of procaine on prevention of skin slap necrosis after modified radical mastectomy in breast cancer.Methods 106 breast cancer patients were randomly divided into treatment and control groups.In the treatment group,procaine(1% 100ml diluted in 300ml mormal saline,42℃)were compressed under the skin flap in operation,the control group received same amount of normal salin instead.The rates and sizes of skin flap necrosis were obeserved and compared.Results There were 13 cases suffured from skin flap necrosis among 106 breast cancer cases who received surgery operation.The rate of the flap necrosis in treatment group was5.76%(3/52),and the control group was 18.51%(10/54),there was significant difference(P

A Case of Breast Reconstruction Using Pedicled TRAM Flap in Psoriasis Patient

Psoriasis is a common and unpredictable chronic immune mediated disease charcterised by skin lesions and associated with arthritis. Complete remission is very rare. Prevention of acute exacerbation is mainstay of the treatment. At present, risk of surgery in psoriasis patient is uncertain although some dermatologic literatures reported that well controlled psoriasis is usually not cause surgical complications. We experienced a case of wide necrosis of flap in chronic psoriasis patient after immediate breast reconstruction with pedicled transverse rectus abdominis flap. Psoriasis is well known to have chronic skin damage from characteristic histopathologic findings of Munro's micro abscess, dermal arteriolar tortursity and hyperplasia. Such pathologic feature may induce congestion of flap and wide necrosis of flap.