Prompt, Objective, and Accurate Measurement of Rat Abdominal Flap Blood Flow Using Laser Speckle Flowgraphy.

Background: The indications for free flap procedures have expanded, with recent technical advances enhancing procedural safety. However, few objective indicators exist to monitor flap status during and after the operation. This experimental study assessed laser speckle flowgraphy (LSFG) as a prompt and accurate indicator of free flap blood flow. Methods: After elevating bilateral lower abdomen flaps with superficial inferior epigastric artery (SIEA) and superficial inferior epigastric vein vasculature in Wistar rats, the right flap with the SIEA was cut (ischemic group) or the superficial inferior epigastric vein was cut (congestive group), and the unaltered left flaps were monitored using LSFG every 5 minutes for a 30-minute period. Flap survival or necrosis was assessed after 7 days. Results: In the ischemic group, LSFG measurements were significantly lower after cutting the SIEA than beforehand (74% at 5 minutes and 72% at 30 minutes). Similar findings were seen in the congestive group (63% at 5 minutes and 55% at 30 minutes). LSFG measurements were significantly lower in the congestive group than in the ischemic group. Seven days afterward, whereas all right-side flaps with cut vessels were necrotic, all unaltered left-side flaps had survived. Conclusions: Our preliminary results demonstrated that LSFG could objectively identify abnormal blood flow in skin flaps as early as 5 minutes into surgery and predict graft survival. LSFG may potentially enable quick and objective assessment of flap blood flow and reduce the risk of complications and flap loss.

Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty.

OBJECTIVE: The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA. METHOD: Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups. RESULTS: A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)). CONCLUSION: In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.

Which plantar region can predict peripheral arterial disease by using laser speckleflowgraphy?

Laser speckle flowgraphy (LSFG) is a new device that can measure skin blood flow and capture the movement of erythrocytes. However, there are a few reports on the use of LSFG to estimate skin blood flow, especially in the lower extremities. We aimed to compare plantar skin blood flow between patients with and without peripheral arterial disease (PAD) to discern the extent to which LSFG could accurately predict PAD. We prospectively measured the plantar skin blood flow in 28 patients with PAD and 37 participants without PAD at two hospitals from 2017 to 2021, using the ankle-brachial index (ABI) and LSFG. We partitioned the plantar into 12 parts: digits 1-5, medial metatarsal, middle metatarsal, lateral metatarsal, medial arch, middle arch, lateral arch, and heel, and compared the difference between the two groups and the area under the curve (AUC) of each point. Statistical analyses were performed to determine the sensitivity, specificity, false-positive rate, and false-negative rate at high accuracy points of AUC and ABI. There was a significant difference among the 12 points between the two groups, and the ratio using toe 1 and toe 5 was highly accurate. The ratio using toe 1 indicated higher sensitivity (89 vs. 82%), higher false-positive rate (22 vs. 4%), lower specificity (81 vs. 97%), and an equivalent false-negative rate (9 vs. 12%) to that of the ABI. These findings could facilitate the use of LSFG to estimate the skin blood flow condition in the plantar skin. Our results indicate that measuring toe 1 using LSFG could be used to somewhat assess PAD.

Skin Wound Healing of the Adult Newt, Cynops pyrrhogaster: A Unique Re-Epithelialization and Scarless Model.

In surgical and cosmetic studies, scarless regeneration is an ideal method to heal skin wounds. To study the technologies that enable scarless skin wound healing in medicine, animal models are useful. However, four-limbed vertebrates, including humans, generally lose their competency of scarless regeneration as they transit to their terrestrial life-stages through metamorphosis, hatching or birth. Therefore, animals that serve as a model for postnatal humans must be an exception to this rule, such as the newt. Here, we evaluated the adult newt in detail for the first time. Using a Japanese fire-bellied newt, Cynops pyrrhogaster, we excised the full-thickness skin at various locations on the body, and surveyed their re-epithelialization, granulation or dermal fibrosis, and recovery of texture and appendages as well as color (hue, tone and pattern) for more than two years. We found that the skin of adult newts eventually regenerated exceptionally well through unique processes of re-epithelialization and the absence of fibrotic scar formation, except for the dorsal-lateral to ventral skin whose unique color patterns never recovered. Color pattern is species-specific. Consequently, the adult C. pyrrhogaster provides an ideal model system for studies aimed at perfect skin wound healing and regeneration in postnatal humans.

Vibrant soundbridge implantation prior to auricular reconstruction with unilateral microtia-atresia.

We presented the first successful application of VSB implantation prior to auriculoplasty, which can provide hearing improvement in safe conditions and open new strategies for earlier hearing rehabilitation in unilateral microtia-atresia children.

Hallucal thenar index: A new index to detect peripheral arterial disease using laser speckle flowgraphy.

OBJECTIVES: Laser speckle flowgraphy is a technology using reflected scattered light for visualization of blood distribution, which can be used to measure relative velocity of blood flow easily without contact with the skin within a short time. It was hypothesized that laser speckle flowgraphy may be able to identify foot ischemia. This study was performed to determine whether laser speckle flowgraphy could distinguish between subjects with and without peripheral arterial disease. MATERIALS AND METHODS: All subjects were classified based on clinical observations using the Rutherford classification: non-peripheral arterial disease, class 0; peripheral arterial disease group, class 2-5. Rutherford class 6 was one of the exclusion criteria. Laser speckle flowgraphy measured the beat strength of skin perfusion as an indicator of average dynamic cutaneous blood flow change synchronized with the heartbeat. The beat strength of skin perfusion indicates the strength of the heartbeat on the skin, and the heartbeat strength calculator in laser speckle flowgraphy uses the blood flow data to perform a Fourier transform to convert the temporal changes in blood flow to a power spectrum. A total of 33 subjects with peripheral arterial disease and 40 subjects without peripheral arterial disease at a single center were prospectively examined. Laser speckle flowgraphy was used to measure hallucal and thenar cutaneous blood flow, and the measurements were repeated three times. The hallucal and thenar index was defined as the ratio of beat strength of skin perfusion value on hallux/beat strength of skin perfusion value on ipsilateral thenar eminence. The Mann-Whitney U-test was used to compare the median values of hallucal and thenar index and ankle brachial index between the two groups. A receiver operating characteristic curve for hallucal and thenar index of beat strength of skin perfusion was plotted, and a cutoff point was set. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index was explored in all subjects, the hemodialysis group, and the non-hemodialysis (non-hemodialysis) group. RESULTS: The median value of the hallucal and thenar index of beat strength of skin perfusion was significantly different between subjects with and without peripheral arterial disease (0.27 vs. 0.87, respectively; P < 0.001). The median value of ankle brachial index was significantly different between subjects with and without peripheral arterial disease (0.8 vs. 1.1, respectively; P < 0.001). Based on the receiver operating characteristic of hallucal and thenar index, the cutoff was 0.4416 and the sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 95%, 91.7%, and 77.6%, respectively. The correlation coefficients of all subjects, the hemodialysis group, and the non-hemodialysis group were 0.486, 0.102, and 0.743, respectively. CONCLUSIONS: Laser speckle flowgraphy is a noninvasive, rapid, and widely applicable method. Laser speckle flowgraphy using hallucal and thenar index would be helpful to determine the differences between subjects with and without peripheral arterial disease. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index indicated that this index was especially useful in the non-hemodialysis group.

Madelung's disease: long-term follow-up.

Madelung's disease (MD) is a rare lipid metabolic disorder of adipose tissue overgrowth, which has been reported to be related to alcohol abuse. Although it does not affect survival itself, alcoholism and metabolic disorders associated with MD can be life-threatening. Although surgical procedures and classifications have been reported, long-term follow-up has rarely been reported. Here, we report a 61-year-old Japanese man with MD who has been followed-up for 12 years. Lipectomy was performed three times over the first 3 years and a total of 4 kg of adipose tissue was excised. Relapse has not been observed. He was diagnosed with multiple hepatocellular carcinomas (MHC) and placed on dialysis due to hepatorenal syndrome caused by alcoholism. Moreover, one of the MHC ruptured resulting in hemorrhagic shock. The cause of death in MD is not fat proliferation but comorbidities. Long-term observation and multidisciplinary systemic management are necessary for MD patients.

Therapeutic strategies for elbow ankylosis due to heterotopic ossification in patients with severe burns.

BACKGROUND: Heterotopic ossification (HO) occurs frequently in the elbow in burn patients, and extends beyond the anatomical structure. HO of the elbow can cause joint contracture and adversely affect activities of daily living.Currently, there is no effective prophylaxis for HO as the precise underlying mechanism remains unknown. Therefore, there is no choice but to treat HO after it has developed. To date, however, no effective standard treatment has been reported, and therefore treatment methods vary between different facilities. Surgical resection is widely accepted as the only therapeutic option once HO limits functional mobility of the elbow. PURPOSES: Based on past reports, we examined our cases and recommend effective therapeutic strategies. We posed the following three questions: (1) Is the surgical intervention effective or detrimental for elbow ankylosis due to HO? (2) What is the best timing for the intervention? (3) What is the most effective postoperative rehabilitation plan? METHODS: We treated three patients with complete ankylosis of the elbow due to HO after severe burn injury using different protocols. RESULTS: Surgery was performed in two cases and rehabilitation therapy was commenced immediately from the first postoperative day. Both patients showed improvement in the active range of motion in their elbow joints. The other patient did not undergo surgery, and his elbows became fixed in the completely extension position. CONCLUSION: Surgical resection is beneficial for elbow ankylosis due to HO after burn injury. Although the exact surgical timing is still controversial, we recommend that surgery should be performed as soon as possible after improving the skin condition around the elbow and confirming the maturation of HO on radiographs. Early rehabilitation and pain control are also important after surgery.

Massive acute haemoperitoneum and shock from a ruptured ovarian varix.

A 38-year-old woman presented with shock and severe abdominal pain. Abdominal CT scanning demonstrated massive ascites, which was highly suggestive of haemoperitoneum. Diagnostic paracentesis confirmed haemoperitoneum. Urgent operative treatment with ligation of a ruptured ovarian varix successfully controlled the bleeding. She eventually made a full recovery.

Localization of Liv2 as an immature hepatocyte marker in EB outgrowth.

The objective of this study was to establish Liv2, a surface marker of mouse immature hepatocytes (hepatoblasts), as a selection tool for embryonic stem (ES) cell-derived immature hepatocytes by acquiring basic data on Liv2 in normal mouse embryos and by confirming Liv2 expression in mouse ES-derived cells. The estimated molecular weight of Liv2 was 40-45 kDa, and immunoreactivity was definitively detected in the cell membrane of fetal hepatocytes on embryonic day (E) 9.5, declined gradually until E12.5,and subsequently became undetectable. Liv2 was localized on and close to the cell membrane. Embryoid bodies (EB) were formed from mouse ES cells whose undifferentiated state was confirmed with immunostaining of Nanog by the hanging drop method. A few Liv2-positive cells occurred as a cluster in EB outgrowth on day 7, but only some of these were albumin (ALB)-positive on day 13. These cells had the same pattern of immunoreactivity, i.e., localization on the cell membrane, as immature hepatocytes in the developing liver, although there were other types of cells with a different pattern of immunoreactivity that were seen only as a granular pattern in the cytoplasm and without ALB or the neuronal marker nestin. These results suggest thatLiv2 may be useful as a surface marker for immature hepatocytes derived from ES cells.This application would allow for the sole selection of immature hepatocytes and provide a useful tool for regenerative medicine.