Application to Quantify Ulcer Areas and Track Their Progress.

Chronic ulcer treatments, such as those for diabetic foot ulcers and pressure sores, require prolonged treatment periods. Availability of effective objective indicators to determine treatment method efficacy is limited. Ulcer area is the agreed-upon indicator for ulcer healing because it contracts and/or undergoes epithelialization as healing occurs. Ulcer surface properties such as healthy or infected granulation and slough or necrotic tissue are also used. This study aimed to develop a user-friendly application automating the ulcer area measurement process and included a graphical time-series display of ulcer components manually classified by users. Images of ulcers photographed with adjacent circular 1.5-cm diameter stickers were prepared. In the application, users manually categorized and color-coded each image into five component types based on different ulcer characteristics. The application calculated the area of each component in pixels and then estimated the actual area using the sticker area as a reference. It also collated color-coded images and presented graphical illustrations of changes in area over time. The results indicated the application successfully automated area measurements of each ulcer component and graphical displays of changes in ulcer component areas over time. It enabled users to visually track quality changes and the chronic ulcer healing process. Historically, ulcer assessments are subjectively conducted via visual examination by physicians, creating less reproducible, objective data. Although ulcer properties still required manual entry by users, our application streamlined ulcer area measurement and time-course visualization and sets the groundwork for a fully automated artificial-intelligence-driven ulcer diagnosis system.

Replantation and simultaneous free-flap reconstruction of severely traumatic forefoot amputation: a case report.

We report a successful replantation of a severely damaged and partially amputated foot covered by a simultaneous free flap. Arterial thrombosis occurred at the flap anastomosis, causing partial flap loss, which were resolved through re-anastomosis and skin-grafting. The patient resumed full, unassisted ambulation 10 months after replantation.

New microvascular anastomotic device for end-to-side anastomosis using negative pressure; a preliminary study.

We previously developed a device for end-to-end anastomosis powered by negative pressure and demonstrated that using the device allow the operator to anastomose semi-automatically with little stress. Here, we sought to build a device for and demonstrate that negative pressure can also be used in end-to-side anastomosis which is clinically popular as end-to-end anastomosis through animal experiment using rats.The devices were constructed with a laser lithographic/3D-printing machine. Nine SD rats were used. Each of the nine rats underwent end-to-side anastomosis between the superficial epigastric vein and the femoral vein using the device. Rat was anesthetized one week later and the anastomotic site was inspected through operative microscope for patency. The anastomotic site was harvested with the device and the rat was euthanized. The anastomotic site was embedded in epon, sectioned, stained with toluidine blue, and analyzed with light microscopy. Eight of the nine anastomoses were patent immediately after the procedures, and two of the nine were patent at 1 week after the procedures. In the failed cases, the vessels dislocated from the device because the clamps loosened during the observation period after the operation. The experiments have shown that the device using negative pressure can also be applied to end-to-side microvascular anastomosis. The patency rate is low and further improvement is required.

Successful microsurgical lip replantation: Monitoring venous congestion by blood glucose measurements in the replanted lip.

Replantation of an amputated lip using microvascular anastomosis is the best option for restoration of the defect. However, the amputated region often lacks veins with appropriate diameters for microvascular anastomoses and typically necessitates both postoperative exsanguination using medicinal leeches and a blood transfusion. We present a case of the successful replantation of an avulsed lip in which postoperative congestion was evaluated objectively by measuring blood glucose levels in the replanted region. The patient presented to our hospital with an upper lip avulsion that was caused by a dog bite. The lip was replanted by the microvascular anastomoses of one artery and two veins using interposed vein grafts. The replanted lip showed signs of congestion on postoperative day one; exsanguination using medicinal leeches was attempted, while blood glucose levels were measured every three hours. Critical congestion, which did not occur in this patient, was defined as a blood glucose level lower than 40 mg/dL. Lip replantation was successful without any complications in this patient.

Monitoring free flap venous congestion using continuous tissue glucose monitoring: A case report.

Blood glucose levels (BGLs) are a good indicator of postoperative venous congestion caused by a thrombus at the anastomotic site of a free flap. Tissue glucose levels (TGLs) are believed to be superior to BGLs for two reasons: TGLs are thought to represent a tissue's congestive status more directly than BGLs and are able to be measured by a continuous tissue glucose monitoring device (CTGMD), whereas BGLs must be measured manually by sampling the flap, hindering the patient's sleep and increasing the nurse's workload. A case is described in which a postoperative thrombus developed in a free flap vein three times. TGL in the flap was monitored by a CTGMD (Free Style Libre®, Abbott, U.S.A.), and BGL was monitored in parallel by conventional sampling of the flap. When venous congestion developed at the anastomotic site, TGLs decreased faster than BGLs; after the congestion was ameliorated by exsanguination, BGLs increased faster than TGLs, indicating that TGLs are a better indicator of venous thrombosis at the anastomotic site than BGLs.

New microvascular anastomotic ring-coupling device using negative pressure.

INTRODUCTION: Many microvascular anastomoses have been performed with Unilink devices, and their advantages have been discussed in the literature over the past few decades. However, there are two drawbacks that have not been addressed and that have limited the development of next-generation microvascular anastomotic devices. First, the Unilink device has metallic pins for fixing vessel walls that remain permanently in the body. Second, the surgeon must manually attach vessel walls to the device. A novel microvascular anastomotic ring device, which uses negative pressure as an atraumatic force to semiautomatically fix the vessel walls, was built and tested in rats. METHODS: The device was designed with three-dimensional computer-aided design (3D-CAD) software, constructed with laser lithography, and tested in the femoral veins of eight rats. At 2 weeks' post implantation, the vein was exposed again, and the patency was examined subjectively. The specimens were examined with light and scanning electron microscopy. RESULTS: Of the eight devices, one broke during the implantation procedure and was omitted from the study. The other seven veins were successfully anastomosed by the devices. Two weeks later, six of the seven veins remained patent, and one had separated. In the patent specimens, endothelialisation was complete, and no thrombus formation was found. CONCLUSIONS: A novel microvascular anastomotic ring device that uses negative pressure to semiautomatically fix the vessel walls without requiring metallic pins was successfully designed.