Comparison of contraction rates of epigastric and extended dorsal island skin flaps in rats.

Flap surgery is a wide field in plastic and reconstructive surgery practice and experimental research is needed to improve surgical success. These research is often performed on rats. Rat is a loose-skinned animal and contraction of skin flaps on rats is an underestimated condition. Besides this variable contraction of survived and necrotic tissues may mislead calculations and results. In this study, contraction patterns of epigastric and dorsal island skin flaps were investigated to identify this phenomenon. Forty-two male Sprague-Dawley rats were divided into four groups. Eleven epigastric flaps with unilateral pedicles, 11 epigastric flaps with bilateral pedicles, 10 extended dorsal island skin flaps with unilateral pedicles, and 10 extended dorsal island skin flaps with bilateral pedicles were prepared. Total, necrotic and viable flap areas were calculated from standardized photographs which were taken daily. The animals were placed on marked papers and image processing software was used the calculate flap areas from the photographs. Respect to these daily flap areas, the contraction rates in epigastric flaps were highly significant. The area loss in necrotic tissues were faster than the viable areas. Compared to the epigastric flaps, the contraction was not significant in extended dorsal island skin flaps flap groups. In conclusion, the rat extended dorsal island skin flap is a more reliable model for experimental flap research, which is resistant to contraction, when compared to the epigastric skin flap model.

A Rare Type of Upper Extremity Injury: Penetrating Injuries Caused by Blunt-edged Items.

BACKGROUND: Penetrating upper extremity injury is a common encountered cause of significant loss of labor force and it is generally caused by sharp items. This article presents five rare cases of penetrating hand and forearm injury caused by blunt-edged items in conjunction with a detailed discussion of the mechanism and management of the injury. METHODS: Five patients with a mean age of 37.6 were treated for upper extremity trauma caused by "blunt-edged items" such as corrugated iron fence, garden wires, iron stick or iron safety fence between 2009 to 2014. All patients were operated under general anesthesia after performing detailed physical examination and x-ray imaging. RESULTS: The explorative surgery of the affected limbs revealed no nervous or vascular injury. In two patients, partial tear of the muscles bellies of intrinsic hand muscles (opponens pollicis and adductor pollicis); in two patients, partial extensor digitorum communis tendon laceration and in the remaining patient, partial tear of the third annular pulley were the only encountered injuries. The physical examinations performed in the last visit of each patient revealed, complete healing of the affected limb without any functional, vascular or sensorial deficiency in a mean follow-up period of 19.2 months. CONCLUSIONS: Despite their initial horrible appearance, injuries caused by "blunt-edged items" are quite harmless to the affected limb because they follow weak anatomic spaces of the extremity and cause minimal tissue damage leaving all vascular and nervous structures intact.

Repair of critical size defects using bioactive glass seeded with adipose-derived mesenchymal stem cells.

Bioactive glass has been demonstrated as a biocompatible bone substitute. However bone healing process can be prolonged due to late resorption of the material. Adipose derived stem cells (ASC) have osteogenic differentiation potential and hence can be a cell source for bone regeneration. The aim of this study was to test whether combination of bioactive glass with ASCs would enhance bone regeneration. Following creation of critical sized defects on the calvaria of 32 Wistar rats, the animals were randomly divided into four groups: Group C (control): Defects were left untreated; Group G: Defects were covered with autologous bone graft; Group BG: Defects were filled with bioactive glass; Group BG/ASC: Defects were filled with bioactive glass seeded with ASCs. The defect size was significantly greater in Group C compared to all other groups. Bone density was significantly lower in Group C compared to Group G and Group BG/ASC. Bone regeneration score of Group C was significantly lower than other groups. Group BG/ASC demonstrated lamellar bone and havers canal formation. The results of this study demonstrated that bioactive glass implanted with ASC is a biocompatible construct stimulating radiologically and histologically evident bone regeneration similar to autologous bone grafting. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1002-1008, 2017.

Risk assessment for free tissue transfers: is old age a determining factor?

INTRODUCTION: Free tissue transfers are more often performed in the elderly with the increase in geriatric patient population. The aim of this study was to investigate the effect of advanced age in reconstructive microsurgery procedures and analyze the association of other variables with complications and surgical success. PATIENTS AND METHOD: A retrospective review of 70 consecutive free tissue transfers between January 2012 and June 2013 was performed. Patients were divided into 2 groups: those younger than 60 years and those aged 60 years or older. Besides demographics, the American Society of Anesthesiologists (ASA) risk score, comorbid conditions, and anatomic locations for surgery (head and neck, extremities, trunk), operative time, need for reoperation, intensive care unit (ICU) admission and blood transfusion, length of hospital stay, medical and surgical complications, as well as partial and total flap loss were noted and analyzed. RESULTS: A total of 71.4% of the patients were younger than 60 years (n = 50; average, 37.4 y), and 28.6% of the patients were 60 years or older (n = 20; average, 67.5 y). None of the other collected data showed significant difference between the groups. Although age was not associated with ICU admission, the location of the reconstruction site and the operative time were found to have a significant correlation with ICU referral. In this series, the operative time correlated with medical complications but not with surgical complications. Higher ASA scores did have a negative effect on the incidence of medical complications (P = 0.028). CONCLUSIONS: This retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction. However, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers.

Delayed reduction of a displaced zygomatic arch fracture by external traction.

An easy and useful method designed for the reduction of delayed and displaced zygomatic arch fractures used by the treatment of a 33-year-old female patient is presented.

Subacute massive edema of the submandibular region after frenuloplasty.

An unusual complication, subacute massive edema of the submandibular region, encountered after a conventional frenuloplasty procedure in a 3-year-old boy is presented.