The Arterial System of the Fasciocutaneous Deltoid Flap Pedicle on 320-Detector Row Computed Tomography and Clinical Application in the Foot and Hand.

BACKGROUND: Fasciocutaneous free deltoid flaps are used to reconstruct hand, foot, and maxillofacial defects. Although anatomical studies of this flap pedicle have been performed on cadavers, there are no reports on the use of 320-detector row computed tomography angiography (CTA-320) to investigate the deltoid flap pedicle in living humans. This study aimed to investigate the arterial characteristics of the deltoid flap pedicle using the CTA-320 system in living humans. METHODS: Twenty-seven adult Vietnamese patients with 54 healthy deltoid regions underwent CTA-320 to investigate arterial blood supply before clinical free-flap transfer. Two- and three-dimensional reconstruction images of the arterial pedicle were visualized, and clinical reconstruction results were evaluated. RESULTS: The cutaneous vessel branches of the deltoid flap were separated from the posterior circumflex humeral artery (PCHA) and originated from the axillary (77.78%), subscapular (12.96%), and brachial (9.26%) arteries. The PCHA penetrated the quadrangular space in 90.74% of patients. The cutaneous arterial branch was present in the deltoid-triceps groove in 100% of patients. The average diameter and length of the PCHA were 3.38 ± 0.58 and 43.08 ± 6.60 mm, respectively. The average diameter and length of the flap cutaneous branch were 1.49 ± 0.28 and 44.57 ± 4.83 mm, respectively. The findings of CTA-320 were aligned with the intraoperative clinical findings well. All deltoid flaps were successfully free-transferred with good outcomes. CONCLUSION: The CTA-320 is a practical and effective method for investigating deltoid flap pedicles. It enables accurate flap design and harvesting of flaps, thereby enhancing the clinical success of free-flap transfer.

In vitro biodegradation behavior of biodegradable hydroxyapatite coated AZ31 alloy treated at various pH values.

OBJECTIVES: The aim of this study is to evaluate the effect of pH treatment on the formation of hydroxyapatite (HA) coating layer and the biodegradation rate of hydroxyapatite coated AZ31 alloy for applications in biodegradable implants. METHODS: HA was grown on the surface of AZ31 substrate at three different pH solutions of 7.5, 9.0, and 10.5 respectively by chemical solution treatment method. The coated samples were evaluated their biodegradation behavior by immersion test in the simulated body fluid (SBF) for 14 days. The biodegradation rate of the samples during immersion test was observed by Mg2+ ion quantification method and measuring the increase of pH of the medium. RESULTS: HA coatings were successfully grown on the AZ31 substrate at three different pH conditions. The sample coated at pH 7.5 showed its uniform and dense coating layer resulted in highest corrosion resistance. While the highest biodegradation rate was observed for the sample coated at pH 10.5 due to many micro-cracks formed in the HA layer. After 14 days of immersion, Mg(OH)2 and calcium phosphate were corrosion products on the surface of the specimens coated at pH 10.5 and pH 9.0 respectively. While HA almost remained on the surface of sample coated at pH 7.5. CONCLUSION: AZ31 alloy coated with HA at pH 7.5 has lowest biodegradation rate and become suitable for applications in biodegradable implants.

Prefabrication of 3D cartilage contructs: towards a tissue engineered auricle--a model tested in rabbits.

The reconstruction of an auricle for congenital deformity or following trauma remains one of the greatest challenges in reconstructive surgery. Tissue-engineered (TE) three-dimensional (3D) cartilage constructs have proven to be a promising option, but problems remain with regard to cell vitality in large cell constructs. The supply of nutrients and oxygen is limited because cultured cartilage is not vascular integrated due to missing perichondrium. The consequence is necrosis and thus a loss of form stability. The micro-surgical implantation of an arteriovenous loop represents a reliable technology for neovascularization, and thus vascular integration, of three-dimensional (3D) cultivated cell constructs. Auricular cartilage biopsies were obtained from 15 rabbits and seeded in 3D scaffolds made from polycaprolactone-based polyurethane in the shape and size of a human auricle. These cartilage cell constructs were implanted subcutaneously into a skin flap (15 × 8 cm) and neovascularized by means of vascular loops implanted micro-surgically. They were then totally enhanced as 3D tissue and freely re-implanted in-situ through microsurgery. Neovascularization in the prefabricated flap and cultured cartilage construct was analyzed by microangiography. After explantation, the specimens were examined by histological and immunohistochemical methods. Cultivated 3D cartilage cell constructs with implanted vascular pedicle promoted the formation of engineered cartilaginous tissue within the scaffold in vivo. The auricles contained cartilage-specific extracellular matrix (ECM) components, such as GAGs and collagen even in the center oft the constructs. In contrast, in cultivated 3D cartilage cell constructs without vascular pedicle, ECM distribution was only detectable on the surface compared to constructs with vascular pedicle. We demonstrated, that the 3D flaps could be freely transplanted. On a microangiographic level it was evident that all the skin flaps and the implanted cultivated constructs were well neovascularized. The presented method is suggested as a promising alternative towards clinical application of engineered cartilaginous tissue for plastic and reconstructive surgery.

Optimization of platelet isolation and extraction of autogenous TGF-beta in cartilage tissue engineering.

Platelets are enriched with Transforming Growth Factor-beta (TGF-beta). However, information is limited concerning TGF-beta's effects at the molecular level. Nevertheless, it has been demonstrated that TGF-beta activates cell proliferation and its positive influence on cartilage formation has been proven within the field of Tissue Engineering (TE). As Platelet Rich Plasma (PRP) contains TGF-beta, it was the purpose of this study to optimize PRP-isolation for further TGF-beta extraction. Red blood cell count (RBC) was separated from whole blood by centrifugation. From the supernatant PRP and platelet poor plasma (PPP) layer, the latter supernatant was re-centrifuged to extract PRP. Various experimental series were run to investigate influences concerning anticoagulating alternatives, different amounts of buffer, various centrifugal forces, or substituting centrifugation for sedimentation. TGF-beta levels were determined using ELISA. The technique of platelet-/ TGF-beta-extraction described here proves to be more effective than other methods, is easily repeatable and not time-consuming, which predisposes it for TE requirements.

Complete middle forearm amputations after avulsion injuries--microsurgical replantation results in Vietnamese patients.

BACKGROUND: Replantation after complete avulsion amputations at the level of the middle forearm is rarely reported in the literature and remains one of the most difficult challenges for microsurgeons. Microsurgery and its clinical applications are new procedures in Vietnam. The purpose of this article is to evaluate our replantation results in Vietnamese patients relating to this type of injury using microsurgical techniques. METHODS: Ten replanted patients after complete avulsion amputations of the middle forearm, operated on at the Department of Trauma and Orthopedics in the Central University Hospital 108 in Hanoi, Vietnam during a 7-year period (between September 1999 and April 2006) were reviewed and subsequently evaluated. All patient information was reexamined and documented. RESULTS: All replants had survived. All cases of bone stabilization using plates and screws (3 of 10 cases) were postoperatively infected and required supplemental intervention with flap reconstructions, whereas this was not observed in seven other patients receiving Kirschner wires (KW) combined with cerclages. Replantation was performed in a patient associated with plexus brachialis paralysis of the affected limb, which was not detected before the procedure. The combined postoperative functional outcomes rated from "excellent" to "fair" in 70% of cases based on an average follow-up period of 20 months. CONCLUSION: With respect to social and psychologic effects, performance of the procedure is extremely worthwhile because it not only provides complete limb preservation, but also has excellent potential for a favorable functional outcome.

Neovascularization in prefabricated flaps using a tissue expander and an implanted arteriovenous pedicle.

Creating prefabricated flaps using tissue expanders in combination with the implantation of maximal blood flow vascular pedicles into suitable tissue areas represents a new tendency in the reconstruction of large skin defects. In 42 Chinchilla Bastard female rabbits weighing 3,700-4,600 g, skeletonized arteriovenous pedicles with maximal blood flow, dissected from the femoral and saphena magna bundles, were implanted underneath abdominal fasciocutaneous flaps. Oval tissue expanders of 250 ml were placed and fixed on the abdominal wall to expand these prefabricated flaps. The evaluation parameters were macroscopic observation, blood analysis, selective microangiography, histology, and scintigraphy. The study results showed that neovascularization in expanded prefabricated flaps was established from newly formed vessels generated from the implanted pedicles and their vascular connections with the originally available vasculature in the flap. After 20 days of prefabrication, the entirety of the expanded prefabricated flaps was perfused by blood flow supplied from newly implanted arteriovenous pedicles. The study indicated that an expanded prefabricated flap can be successfully created by the simultaneous implantation of a maximal blood flow pedicle in combination with flap expansion.