Extracorporeal shock wave treatment in ischemic tissues: what is the appropriate number of shock wave impulses?

The dose-dependent effect of extracorporeal shock wave technology (ESWT) was evaluated using a murine skin flap model. Thirty-six Sprague-Dawley rats were divided into six groups (ESWT groups 1 through 5 and a control group). After surgery, shock wave impulses doses were administered: 200 (group 1), 500 (group 2), 1500 (group 3), 2500 (group 4), 5000 (group 5), and 0 (control group 6). Flap viability was evaluated on day 7. Overall, significantly smaller percentages of necrotic zones were observed in groups 2, 3, and 4 compared with groups 1, 5, and the control group ( P < 0.05). ESWT treatment with 200 impulses was found to be ineffective. ESWT treatment of 5000 impulses resulted in a significant increase in the percentage of necrosis compared with other ESWT groups ( P < 0.05). However, ESWT treatments between 500 and 2500 impulses at 0.11 mJ/mm (2) enhanced epigastric skin flap survival significantly.

Shock wave therapy reduces necrotic flap zones and induces VEGF expression in animal epigastric skin flap model.

The effect of extracorporeal shock wave (ESW) therapy on skin flap survival and growth factor expression was investigated in a rat model using epigastric skin flap. Treatment and control groups each contained 20 animals. ESW effectively enhanced epigastric skin flap survival by significant reduction of areas of necrotic zones. At day 7 after the operation, necrotic zones of 4.2% were found in the ESW-treated group compared with 18.3% in the control group ( P < 0.01). Concomitantly, in tissue samples adjacent to the necrosis areas, increased vascular endothelial growth factor expression was observed in the ESW-treated animals (median 84.5%, range 57.4 to 94.5%) compared with the control group (median 46.7%, range 29.1 to 93.1%; P < 0.1). However, for expression of basic fibroblast growth factor, no difference was found between the two groups. The authors conclude that the success of the shock wave treatment may partly be due to modulation of growth factor expression.

Analysis of publications in three plastic surgery journals for the year 2002.

The goal of this study was to analyze the publications in the plastic surgery literature for the year 2002. Contents of these articles, authors' information (such as nationality affiliation of the first author), type of institution, presence of grant support, and previous presentation were analyzed. For inclusion in this study, the publications had to be original articles from the three most frequently read general plastic surgery journals: Annals of Plastic Surgery, British Journal of Plastic Surgery, and Plastic and Reconstructive Surgery. With this approach, 533 articles were included in the study. To give a cross-sectional analysis of the content of all articles, 11 distinct categories were created in which all the articles were subsummarized. The categories were based on anatomical regions and specific plastic surgical areas. A summary is given for each of the categories to provide an overview of the field in which most of the research in plastic surgery was taking place in 2002 and which topics were focused on. The authors found that only 7 percent of all articles had grant support, whereas 36 percent of articles were presented previously during a scientific meeting. Most of the articles came from university-based institutions (68 percent), followed by non-university-based institutions (29 percent) and private practice (3 percent). Regarding nationality affiliation, most of the articles came from the United States (n = 229) and Europe (n = 128); in Asia, Turkey (n = 39) and Japan (n = 36) were the countries with the most published articles.

One-stage breast reduction and nipple-areolar reconstruction.

The authors present an easily designed and accomplished technique of one-stage reduction mammaplasty and nipple-areolar reconstruction for patients with large or medium-size breasts and for patients missing the nipple-areolar complex. The technique has low inherent risks, and the symmetry of the breast is maintained to the maximum. In addition to the cosmetic improvement, using this technique benefits the patient further by avoiding postoperative corrections or adjustments.