Lymphatic patterns in the superficial circumflex iliac artery perforator flap.

BACKGROUND: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer (LIFT) technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the superficial circumflex iliac artery perforator flap. METHODS: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24-minutes after indocyanine green lymphography (ICG) injection. Standardized procedures were implemented for all participants in both hospitals. RESULTS: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the superficial circumflex iliac artery perforator flap were oriented towards the inguinal lymph node. However, the left SCIP zone lymphatic vessels were directed opposite to the inguinal lymph node. CONCLUSION: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was towards the inguinal lymph node, although only single side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

Lymphaticovenous anastomosis in rabbits: A novel live experimental animal model for supermicrosurgical training.

BACKGROUND: Lymphaticovenous anastomosis is widely used in lymphedema management. Although its effectiveness in reducing edema in patients can be clinically observed, evaluating the long-term outcomes of this technique can be complex. This study established an animal model to assess the outcomes of lymphaticovenous anastomosis technique at 15 and 30-days post-surgery using indocyanine green lymphography, Patent Blue V dye injection, and histopathological examination. METHODS: An experimental model was established in the hindlimbs of 10 rabbits using the popliteal vein and afferent lymphatic vessels in the popliteal area. The subjects were divided into two groups: the first group (n = 5) underwent patency assessment at 0 and 15 days, and the second group (n = 5) at 0 and 30-days, resulting in 20 anastomoses. Patency was verified at 0, 15, and 30-days using indocyanine green lymphography and Patent Blue V injection. Histopathological examinations were performed on the collected anastomosis samples. RESULTS: The patency rate was 90% (19/20) initially, 60% (6/10) at 15 days post-surgery, and 80% (8/10) at 30-days. The average diameter of lymphatic vessels and veins was 1.0 mm and 0.8 mm, respectively. The median number of collateral veins was 3; the median surgical time was 65.8 min. Histopathology revealed minimal endothelial damage and inflammatory responses due to the surgical sutures, with vascular inflammation and thrombosis in a single case. Local vascular neoformations were observed. CONCLUSION: This study highlights the reliability and reproducibility of using rabbits as experimental models for training in lymphaticovenous anastomosis technique owing to the accessibility of the surgical site and dimensions of their popliteal vasculature.

Risk-of-bias assessment of the randomized clinical trials and systematic reviews on surgical treatments for breast cancer-related lymphedema: A mapping review.

BACKGROUND: Breast cancer treatment is the principal cause of lymphedema in the upper extremities. Breast cancer-related lymphedema (BCRL) treatments were previously based on conservative therapy; surgical treatments are alternative options that could be highly beneficial, especially for patients who are not responsive to conservative therapy. The main aim of this study was to describe and critically assess the risk of bias of randomized clinical trials (RCTs) and systematic reviews (SRs) on surgical treatment for BCRL. METHODS: We conducted an evidence mapping review according to the methodology proposed by Global Evidence Mapping (GEM). An update was done for our previous systematic search in MEDLINE, EMBASE, CENTRAL (Cochrane), and Epistemonikos from the year 2000 onward. We assessed the risk of bias for the RCTs and SRs using the RoB-2 and ROBIS tools, respectively. RESULTS: Two surgical RCTs and eight SRs were found among the 47 surgical studies that met the eligibility criteria. The overall risk-of-bias assessments of these studies were rated as some concerns (six outcomes) and high risk (three outcomes) for the measured outcomes among the RCTs and as a high risk of bias (five studies) and low risk (three studies) for the included SRs. CONCLUSIONS: The overall evidence in the literature on surgical treatment for BCRL is low, as there are few published RCTs and SRs, and the risk-of-bias assessment for the majority was rated as high risk of bias or with some concerns. High-quality studies are needed to improve evidence-based decision-making by surgeons and patients.

Popliteal Vascular Lymph Node Resection in the Rabbit Hindlimb for Secondary Lymphedema Induction.

Lymphedema is a common condition often associated with cancer and its treatment, which leads to damage to the lymphatic system, and current treatments are mostly palliative rather than curative. Its high incidence among oncologic patients indicates the need to study both normal lymphatic function and pathologic dysfunction. To reproduce chronic lymphedema, it is necessary to choose a suitable experimental animal. Attempts to establish animal models are limited by the regenerative capacity of the lymphatic system. Among the potential candidates, the rabbit hindlimb is easy to handle and extrapolate to the human clinical scenario, making it advantageous. In addition, the size of this species allows for better selection of lymphatic vessels for vascularized lymph node resection. In this study, we present a procedure of vascular lymph node resection in the rabbit hindlimb for inducing secondary lymphedema. Anesthetized animals were subjected to circumferential measurement, patent blue V infiltration, and indocyanine green lymphography (ICG-L) using real-time near-infrared fluorescence, a technique that allows the identification of single popliteal nodes and lymphatic channels. Access to the identified structures is achieved by excising the popliteal node and ligating the medial and lateral afferent lymphatics. Special care must be taken to ensure that any lymphatic vessel that joins the femoral lymphatic system within the thigh without entering the popliteal node can be identified and ligated. Postoperative evaluation was performed at 3, 6, and 12 months after induction using circumferential measurements of the hindlimb and ICG-L. As demonstrated during follow-up, the animals developed dermal backflow that was maintained until the 12th month, making this experimental animal useful for novel long-term evaluations in the management of lymphedema. In conclusion, the approach described here is feasible and reproducible. Additionally, during the time window presented, it can be representative of human lymphedema, thus providing a useful research tool.

Rhinoplasty with Recycled Dorsum Preservation: Technique and Outcomes.

Rhinoplasty is one of the first surgical procedures described with evidence in the history of medicine. At first, these were performed for the reconstruction of traumatic defects caused by punishments, sequels of war, and then it had been reused after suffering from diseases such as syphilis. Many techniques have been developed from the need of aesthetics outcomes in this field. The objective of our work is to describe a modified approach of recycled dorsum preservation procedure that we have proposed as a safe and reliable technique. In this work, we have showed that this technique has a marked advantage of preserving the natural tissue with satisfactory postoperative result. We had no functional complications up to date. We recommend that every specialist in the field of rhinoplasty should be able to use it as a reproducible and feasible alternative.

Evaluation of needle injection practices contributing to Campylobacter contamination in New Zealand chicken and chicken products.

One hypothesis for the higher rate of campylobacteriosis in New Zealand (NZ) is that secondary poultry processing practices increase chicken contamination. Chicken marination with needle injection may introduce pathogenic bacteria from the surface deep into the interior muscle tissue. The survival of Campylobacter in/on multi-needle injected chicken products was performed at the processing plant and retail. The 'reduced salts' marinade was not effective in reducing Campylobacter contamination level as the 'high salt' marinade. At the plant, every tested single injected drumstick with 'reduced salt' marinade was contaminated with Campylobacter with up to 3.5 log per drumstick where only 30% of the injected drumsticks with the 'high salt' marinade were contaminated on the surface. At retail, chicken products injected with the 'low salt', the contamination was very low or undetectable as all the products were sold frozen, but the chicken products injected with 'high salt' marinade were sold fresh, and the contamination level varies and can marginally exceed the target Campylobacter contamination limit (3.78 log CFU/carcass) set by The NZ Authority. The multi-needle injection practice tested in this study did not indicate that the marination process could increase the contamination level on chicken or chicken products.

Evidence Mapping of the Treatments for Breast Cancer-related Lymphedema.

Women treated for breast cancer are facing a lifetime risk of developing lymphedema, which occurs in up to 40% of this population. There is a lack of evidence and limited knowledge regarding the treatment of breast cancer-related lymphedema (BCRL). The aim of this study was to identify, describe, and organize the currently available evidence in the treatment of BCRL. METHODS: We conducted an evidence mapping review study according to the methodology proposed by Global Evidence Mapping. We performed a systematic search in Medline, Embase, Central (Cochrane), and Epistemonikos, from 2000-2020. We included studies about all treatment types for BCRL, including surgical and nonsurgical treatment. Results were summarized in narrative and tabular forms. RESULTS: A total of 240 studies were included in this mapping review, distributed as follows: 147 experimental studies [102 randomized clinical trials (RCTs) and 45 quasi-experimental clinical trials], 48 observational studies (34 prospective and 14 retrospective studies), and 45 systematic reviews (17 of them with metanalysis). Most of the RCTs were on nonsurgical interventions. Only two RCTs addressed surgical intervention. CONCLUSIONS: In the last 20 years, there were an average of 12 publications per year on the treatment of BCRL. Recently this lack of attention has been partially corrected, as the majority were published in the past 5 years. However, most of them were on nonsurgical interventions. Well-designed RCTs on surgery are needed to measure the effectiveness of the applied interventions.

Survey of New Zealand Poultry Consumers' Handling of Raw Poultry and Food Safety Awareness To Provide Insight into Risk Factors for Campylobacteriosis.

ABSTRACT: New Zealand (NZ) has a high rate of reported campylobacteriosis cases. Cross-contamination in home kitchens during poultry handling is considered the main factor in campylobacteriosis transmission. The main aim of this study was to measure NZ consumers' food safety awareness and self-reported food safety practices associated with handling raw poultry. This study will contribute to the existing knowledge to explain the reasons behind the increase of campylobacteriosis incidents. Findings can help inform future consumer education campaigns to help reduce the incidence of campylobacteriosis in NZ. A cross-sectional survey composed of 31 multiple-choice questions was designed, piloted, and used to collect information about the last time consumers purchased and prepared raw poultry at home. A street-intercept survey in public places, such as supermarkets in the Canterbury region, was used to recruit respondents for this study. A descriptive and inferential data analysis was performed, including a one-way analysis of variance test used to compare the mean scored responses of the respondents among different sociodemographics. Overall, 301 valid responses were obtained. Scores representing reported safe food practices ranged between 2 and 19 (maximum 21), with a mean score of 9.83 (standard deviation of 3.50 with a standard error of 0.20). There was some variation in correctly answered questions by respondents for food hygiene (25%), cross-contamination prevention (55%), temperature control and storage practices (49%), and food safety (52%). Approximately 30% of the respondents reported symptoms of a foodborne disease experienced once to four times during the past 12 months. The study identified low adherence to current recommended food safety practices, including safe food storage and temperature control. The findings can be used to inform a communication campaign regarding food safety needs to be designed urgently in NZ to reduce the rate of campylobacteriosis.

Thermal inactivation and kinetic parameters for Campylobacter jejuni on chicken skin.

New Zealand has a higher reported incidence rate of campylobacteriosis than other developed countries. It has been suggested that this may be due to the emergence of heat-resistant strains that can survive normal cooking. To test this, typed Campylobacter strains ST474 and ST48 were inoculated onto slices of chicken skin <18 mm in diameter and 4 mm thick using a pipette, and placed in a special aluminium cell, which was heated to a predetermined temperature (in the range of 56.5 to 65 °C) using a temperature-controlled water bath. Survivor curves were plotted, and GlnaFit software was chosen to fit the experimental data; inactivation parameters were estimated using 1-step and 2-step regression. The D values and z values were in the range of 3-6 s and 8-11 °C, respectively. The D values at 60 and 56 °C were in the range of 12-41 s. These D values are in general agreement with previously published reports. Thus, New Zealand's higher reported rate of campylobacteriosis is possibly due to factors other than the emergence of heat-resistant strains.

Domestic food preparation practices: a review of the reasons for poor home hygiene practices.

New Zealand has a much higher rate of reported campylobacteriosis cases than the rest of the developed world. It has been suggested that New Zealanders have worse home hygiene practices during food preparation than the citizens of other developed countries. Thus, it is necessary to recognize and understand the reasons for consumer's poor practices in order to help develop a more effective message to improve New Zealanders' practices in the domestic environment. This could in turn lead to a reduction in the number of campylobacteriosis cases. The objective is to review cited literature on consumer practices which is related to food poisoning and to attempt to list the factors related to poor consumer practice. There are many internationally identifiable reasons for the poor practices of consumers. These reasons include psychological, demographic and socioeconomic variables; personal interest in new information; prior knowledge; cultural influence; educational background; perception of risk, control and liability; and attitude towards the addressed practices or hazards. The results have indicated that 'optimistic bias', the 'illusion of control', habits and lack of knowledge concerning food safety during domestic food preparation are prevalent among consumers. The research indicated the influence of demographic factors (age, gender, level of education, income, work hours, race, location, culture), as they play a potential role in determining domestic food safety behaviour. It appears that all these factors are applicable for New Zealand consumers and should be addressed in any future education strategy aimed at improving New Zealanders' food handling practices.

Thermal inactivation of Campylobacter jejuni in broth.

New Zealand has a high rate of reported campylobacteriosis compared with other developed countries. One possible reason is that local strains have greater heat tolerance and thus are better able to survive undercooking; this hypothesis is supported by the remarkably high D-values reported for Campylobacter jejuni in The Netherlands. The objective of this study was to investigate the thermal inactivation of isolates from New Zealand in broth, using strains that are commonly found in human cases and food samples in New Zealand. Typed Campylobacter strains were heated to a predetermined temperature using a submerged-coil heating apparatus. The first-order kinetic model has been used extensively in the calculation of the thermal inactivation parameters, D and z; however, nonlinear survival curves have been reported, and a number of models have been proposed to describe the patterns observed. Therefore, this study compared the conventional first-order model with eight nonlinear models for survival curves. Kinetic parameters were estimated using both one- and two-step regression techniques. In general, nonlinear models fit the individual inactivation data sets better than the log-linear model. However, the log-linear and the (nonlinear) Weibull models were the only models that could be successfully fitted to all data sets. For seven relevant New Zealand C. jejuni strains, at temperatures from 51.5 to 60°C, D- and z-values were obtained, ranging from 1.5 to 228 s and 4 to 5.2°C, respectively. These values are in broad agreement with published international data and do not indicate that the studied New Zealand C. jejuni strains are more heat resistant than other strains, in contrast with some reports from The Netherlands.