Photodynamic therapy using methylene blue to treat cutaneous leishmaniasis.

OBJECTIVE: The purpose of this study was to show the efficiency and underlying mechanism of action of photodynamic therapy (PDT) using methylene blue (MB) and non-coherent light sources to treat cutaneous leishmaniasis (CL). BACKGROUND DATA: Systemic treatment can cause severe side effects, and PDT using porphyrin precursors as sensitizers has been used as an alternative to treat CL. MB has been used under illumination or in the dark to treat a wide range of medical conditions, and it exhibits antimicrobial activity against protozoa and viruses. METHODS: In in vitro tests, the cell viability (via a MTT colorimetric assay) of Leishmania amazonensis parasites was evaluated as a function of MB concentration. In in vivo experiments, we analyzed the treatment of two lesions from a patient with leishmaniasis. The patient received a low dose of pentavalent antimony (SbV), and one lesion was treated with PDT. RESULTS: We observed IC(50) decreases from 100 to 20 µM in response to PDT when MB was used in different concentrations in in vitro tests. Use of SbV in combination with the PDT protocol produced faster wound recovery when compared with the use of SbV alone. CONCLUSIONS: The in vitro experiments and the results from the clinical case suggest that the inexpensive PDT protocol that is based on MB and RL50® may be used to treat CL caused by L. amazonensis.

Strauch's technique for epigastric free flaps in rats revisited: a simple and effective method to increase patency rates.

Described by Strauch and Murray in 1967, the rodent epigastric free flap remains a versatile tool for microsurgery research and training. We report herein three sequential phases of our quest to improve efficiency and effectiveness of the original technique, making it more accessible to more microsurgeons. Ninety-six allotransplants were performed. Surgical technique, complication rates, clinical findings, and histopathologic correlation of each phase are reported. In phase I, two experienced microsurgeons employed the original technique and succeeded in 77% of the procedures. In phase II, two junior microsurgeons achieved a patency rate of 16.6% using the same technique, as opposed to 100% in phase III, utilizing the not-yet-described simplified flow-thru technique. Although patency rate using the original method varies from 9 to 78% (according to other reports), this technical modification can increase even the less experienced microsurgeons' success rates, perpetuating the use of Strauch's epigastric flap in experimental microsurgery.

Clinical case of ossifying fasciitis of the hand.

Ossifying fasciitis is a rare benign tumour similar to nodular fasciitis histopathologically, but, morphologically, composed of metaplastic bone with calcification and chondroid differentiation. This lesion may easily be misinterpreted as malignancy, clinically and histologically, because it presents as a rapidly growing mass originating from subcutaneous or deep fascial tissues. These lesions are usually located in upper and lower extremities and trunk. We present a case in which, unusually, it was located in the flexor tendon sheath of the hand, which caused limitation of motion. Clinical suspicion and accurate histopathology of this rare benign lesion is important because it is commonly misdiagnosed as a malignancy and results in unnecessary aggressively wide resection.

Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels.

BACKGROUND: Among various alternatives for autologous breast reconstruction, the superficial inferior epigastric artery abdominal flap provides the least donor-site morbidity, as dissection of the rectus abdominis sheath and muscle is not required. However, because of inconsistencies in the existence and size of the superficial inferior epigastric artery, its use is limited. In addition, whether the perfusion from the superficial system is adequate across the midline is still a question to be answered. METHODS: Over a period of 16 months, the authors performed a total of 44 breast reconstructions using either the deep inferior epigastric artery perforator flap (n = 30) or the superficial inferior epigastric artery flap (n = 14). In all cases, the superficial inferior epigastric artery system was explored first and used as the pedicle if the diameter of the available vessels was larger than 1 mm. If the vessels were unavailable or the diameters were smaller than 1 mm, the deep inferior epigastric artery and vein were used as the pedicle. The diameter of the superficial inferior epigastric artery ranged between 0.8 and 3.0 mm, and the mean pedicle length was 6 cm. The superficial inferior epigastric artery was not available in 21 cases (48 percent), and in nine cases (20 percent) the diameter was smaller than 1 mm. In six cases where the superficial inferior epigastric artery was judged to be appropriate, laser Doppler study was performed perioperatively to assess the perfusion of each zone (I through IV) from the deep and superficial systems consecutively. In all cases, the superficial and deep systems ipsilateral to the defect were dissected. During inset, zone IV was not discarded routinely, and 92.3 percent and 86.7 percent of the harvested superficial inferior epigastric artery flap and deep inferior epigastric artery perforator flap, respectively, were used. RESULTS: The flap survival rates were 93 and 100 percent in the superficial inferior epigastric artery and deep inferior epigastric artery perforator groups, respectively. Adequate perfusion of all zones from the superficial system was documented by laser Doppler flowmetry, and the perfusion rates were comparable to the deep system. CONCLUSIONS: The entire abdominal adipocutaneous flap based on the unilateral superficial inferior epigastric artery is as reliable as one based on the deep inferior epigastric artery perforator flap. As a result, initially, the superficial inferior epigastric artery flap should be explored, as it provides less donor-site morbidity. A sizable superficial artery and vein is sufficiently safe for microsurgical transfer, similar to the deep inferior epigastric system.

Proximal forearm flap based on a septocutaneous vessel from the radial artery.

BACKGROUND: The radial forearm flap has been a workhorse flap for soft-tissue or coverage reconstruction in the head and neck area. Although it has several major advantages, it requires sacrifice of the radial artery. In this article, the authors present their modification of harvesting a forearm flap based on a large septocutaneous branch of the radial artery in the proximal forearm with or without sacrificing the main radial artery. They name it the proximal radial forearm flap. METHODS: From September of 2003 to March of 2004, a total of 14 free proximal radial forearm flaps were used for head and neck reconstruction in 12 patients. There was one female patient and 11 male patients. Their ages ranged from 32 to 85 years. The skin flap size ranged from 2.0 x 6.0 cm to 4.5 x 18 cm. RESULTS: All free proximal radial forearm flap reconstructions had immediate success. There were one delayed flap loss caused by wound infection and one death attributable to advanced medical disease. Six flaps were harvested with preservation of the radial artery trunk. Six of the eight radial arteries that were killed during flap harvest were repaired with a short segment (3 to 4 cm) of vein graft. The average diameter and length of the septocutaneous vessel of the proximal radial forearm flap was 0.73 mm and 3.3 cm, respectively. Two flaps were harvested in conjunction with the conventional free radial forearm flaps. Nine donor sites were closed primarily and five donor sites required skin grafts. CONCLUSIONS: The proximal radial forearm flap can be used successfully in head and neck reconstruction with the advantages of moving the donor site to the proximal forearm for better scar concealment and possible preservation of the radial artery trunk. The disadvantages of this flap are short pedicle length and small pedicle diameter when the radial artery is to be preserved.