ABSTRACT
BACKGROUND: Reconstruction of intractable ulcers on the lateral malleolus is challenging because affected patients suffer various complications. A lateral supramalleolar flap, nourished by the superficial cutaneous branch of the perforating branch of the peroneal artery, has been described as one of the most reliable methods for reconstructing this difficult region. Although the deep descending branch of the perforating branch of the peroneal artery has a tiny cutaneous perforator, a flap based on this perforator has not been described. METHODS: The vascular anatomy of an island flap based on the descending branch perforator of the perforating branch of the peroneal artery was investigated using 20 cadaver legs. Distances from the lateral malleolus and the external diameters were investigated. Based on the anatomical study results, a perforator-based island flap was developed for clinical use and implemented in five cases. RESULTS: The anatomical study revealed the descending branch perforator diameter to be smaller than the superficial cutaneous branch diameter, and the location to be considerably closer to the lateral malleolus. All five island flaps used clinically survived without complications. CONCLUSIONS: A new perforator-based island flap of the descending branch of the perforating branch of the peroneal artery for reconstruction of the lateral malleolus was designed. The territory covered by the flap could be enlarged by including the adjacent angiosome area of the superficial cutaneous branch. This flap elevation technique was uncomplicated and sufficiently straightforward to be used for patients at high risk for complications with extended surgical procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
Subject(s)
Minimally Invasive Surgical Procedures/methods , Perforator Flap/blood supply , Plastic Surgery Procedures/methods , Surgical Flaps/blood supply , Aged , Arteries/surgery , Cadaver , Dissection , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Leg/anatomy & histology , Leg/blood supply , Male , Middle Aged , Sampling Studies , Statistics, Nonparametric , Tarsal Bones/anatomy & histology , Tarsal Bones/blood supply , Tarsal Bones/surgeryABSTRACT
The environment for living organism in space has microgravity and/or hypergravity and/or any kind of mechanical stresses. Cellular response may differ from the variety of mechanical stress. Mitogen-activated protein kinases (MAPKs) pathway is related to various cellular events. In the present study it was investigated the serial measurement of MAPK phosphorylation using western-blotting analysis following with three types of cyclic stretch, static, 0.1 Hz and 0.25 Hz. The result was that induction of MAPK phosphorylation had peaks within 2 to 4 hours and attenuated, while induction of p38 phosphorylation in 0.1 Hz stretch had a peak at 6 hours later and the strongest. Thus, there might be differential cellular response depends upon the frequency of cyclic stretch .
