An Effects of a New PGE1: Lipo-AS013 on Blood Flow and Survival of Skin Flap

Prostaglandin E1(PGE1) is known to have various physiological action such as vasodilatation, decrease of blood pressure, angiogenesis, inhibition of platelet aggregation and so forth. PGE1 has been developed in many different formulations in order to overcome its chemical instability and deactivation in the lungs when administered parenterally. Lipo-AS013 is a potent drug with higher chemical stability and greater vascular wall targeting than others. The study was done on 3x10 cm model flap of dorsal skin of Sprague-Dawley rats and the flap perfusion survival were observed and documented. The flap treated with Lipo-AS013 beforehand was given intravenously Sodium fluorescein 10 minutes later, and then Percent Dye Fluorescence Index(% DFI) was calculated. The results were compared to a control group and the group administered locally epinephrine. In the control group, the % DFI and flap survival rate increased from 54.1+/-6.7 to 65.0+/-2.6(p<0.01) while in Lipo-AS013 group from 55.3+/-2.2 to 67.4+/-1.9(p<0.01), respectively. In the epinephrine group, the % DFI(p<0.05) and flap survival rate(p<0.001) decreased. In the both epinephrine and Lipo-AS013 group Percent DFI and flap survival rate are comparable with the control group. The result indicates that the potent Lipo-AS013 enhances the blood flow and flap survival. This highly potent Lipo-AS013 may have targeting ability and accumulate PGE1 onto the vascular walls. A quantitative analysis of fluorescence on the skin surface is a reliable tool to measure the blood perfusion into an ischemic flap and its viability. Further comparative study with conventional PGE1 and Lipo-PGE1 is needed in order to clarify the action and efficiency of Lipo-AS013.

Successful Treatment of Auricular Arterio-Venous Malformation

Auricular arterio-venous malformation(AVM) is relatively rare and few have been reported in the literature. Two cases, presented here showed pulsating lesions of anterior and posterior auricular or even retroauricular mastoid area. They caused irregular macro and prominent ear compared with the opposite normal ear. After embolization of feeding arteries to the arteriovenous malformations, skin and subcutaneous masses were completely removed and grafted with full thickness skin: one was removed one stage and the other underwent a two stage operations. There were no evidence of recurrence for more than 2 years follow up and esthetic results were promising.

Clinical Application of Extended Lateral Arm Free Flap

Despite of its many advantages, application of the classic lateral arm flap has been limited due to its small skin paddle size, thick subcutaneous tissue, a short vascular pedicle, and inconsistent sensory innervation and recovery. The flap has been used for small to medium sized defects. Keuk and Chuan (1991) reported arterial mapping of the lateral arm through the dye injection study, and the posterior lateral collateral atery passed below the lateral epicondyle an average of 7.9 cm and then anastomosed with rich vascular plexus of the proximal forearm. From March 1997 to April 1998, we have performed 8 extended lateral arm free flaps successfully at various sites such as the face, hand, forefoot, and the heel. All flaps completely survived. We found out the extended lateral arm free flap could be suitable for resurfacing the face, hand and foot because of its long pedicle, very thin and pliable skin paddle. We present diversity for its use and its safety.